Ultrasound-guided catheterization of the subclavian vein: a prospective comparison with the landmark technique in ICU patients

Introduction

Ultrasound (US)-guided internal jugular vein catheterization has been recommended to increase the procedural success rate and to enhance patient safety. However, there are few data on the potential advantages of the use of US guidance for subclavian vein (SV) catheterization. The aim of this study was to evaluate whether US-guided catheterization of SV improves the procedural success rate of the traditional landmark method in ICU patients.

Methods

Ethics Committee approval and written informed consent from all patients or their next of kin were obtained. We prospectively and randomly evaluated an US-guided method in 35 patients undergoing SV catheterization (Group US) and compared the results with 35 patients in whom a landmark-guided technique was used (Group LM). All procedures were performed by the same physician, who was experienced in both techniques. The catheterization success rate at the first attempt, the overall catheterization success rate, the number of attempts, the time to catheterization, and catheterization-related mechanical complications were recorded. Bedside chest X-ray scans were used to evaluate the position of the catheter tip, pneumothorax, and hemothorax.

Results

The groups were similar in terms of physical characteristics, systemic disease, and risk factors for difficult SV catheterization. Catheterization success rate at the first attempt (Group LM 63% and Group US 63%, P = 1.00) and overall success rate (Group LM 94% and Group US 89%, P = 0.67) were similar in both groups. The number of attempts for SV catheterization were no different in the groups (Group LM 1.6 ± 1.0 attempts and Group US 1.7 ± 1.1 attempts, P = 0.61). Three patients in Group LM developed six mechanical complications while four patients in Group US had four such complications (P > 0.05 for all). The time to catheterization was significantly longer in Group US than Group LM (Group LM 178 ± 128 s vs. Group US 230 ± 127 s, P = 0.008).

Conclusion

Compared with the landmark technique, real-time two-dimensional US did not increase the overall or first attempt success rate in subclavian vein catheterization in ICU patients. The time to catheterization was significantly longer with real-time two-dimensional US guidance than with landmark guidance.