Real-time ultrasound-guided subclavian vein cannulation in cardiac surgery: comparison between short-axis and long-axis techniques

Introduction

Central venous catheters play an important role in patient care; however, their use is associated with various complications and more frequently through the subclavian vein (SCV) route. A previous study showed that ultrasound-guided cannulation of the SCV in critical care patients is superior to the landmark method and should be the method of choice in these patients [1]. The aim of this study was to compare short-axis and long-axis approaches for ultrasound-guided subclavian vein cannulation with respect to indicators of success.

Methods

Eighty-three patients undergoing cardiac surgery and requiring central venous cannulation were randomized to receive long- axis or short-axis ultrasound-guided cannulation of the subclavian vein by a skilled anesthesiologist. First-pass success, unsuccessful placement, number of attempts, number of needle passes, skin and vessel puncture, time to successful catheterization and complications were considered as outcomes.

Results

The subclavian vein was successfully cannulated by ultrasound- guided techniques in all patients. Central venous cannulation failed in two and 10 cases respectively with short-axis and long-axis view and the other view was used successfully. The first-pass success rate was significantly higher in the short-axis group (73%) compared with the long-axis group (40%) (P = 0.005). The procedure time, number of attempts, needle redirection, and skin and vessel punctures were significantly lower in the short-axis than long-axis group (P < 0.05). The overall number of complications did not differ significantly between groups even if artery puncture and hematoma occurred more frequently in the long-axis group. Moreover, the need to change the ultrasound- guided insertion technique was more frequent in the long-axis group.

Conclusion

Ultrasound-guided subclavian vein cannulation by an experienced operator has a higher first-pass success rate and lower access time using the short-axis than long-axis approach.