Ultrasound for subclavian central lines (CVC)

Ultrasound guided Internal Jugular CVC is now pretty much standard but see this study published this month in CCM Journal 1.

463 mechanically ventilated patients were compared - the ultrasound-guided subclavian vein cannulation (200 patients) vs. the landmark method (201 patients) using an infraclavicular approach. Patients were stratified with regard to age, gender, and body mass index.

Results:

• No significant differences in the presence of risk factors for difficult cannulation between the two groups of patients were recorded.
• Subclavian vein cannulation was achieved in 100% of patients in the ultrasound group as compared with 87.5% in the landmark one (p < .05).
• Average access time and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < .05).
• In the landmark group, artery puncture and hematoma occurred in 5.4% of patients, respectively, hemothorax in 4.4%, pneumothorax in 4.9%, brachial plexus injury in 2.9%, phrenic nerve injury in 1.5%, and cardiac tamponade in 0.5%, which were all increased compared with the ultrasound group (p < .05).
• Catheter misplacements did not differ between groups.

Conclusions: The present data suggested that ultrasound-guided cannulation of the subclavian vein in critical care patients is superior to the landmark method and should be the method of choice in these patients.

Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study - Critical Care Medicine. 39(7):1607-1612, July 2011.