Objective: Subclavian vein catheterization may cause various
complications. We compared the real-time ultrasound-guided subclavian
vein cannulation vs. the landmark method in critical care patients.
Design: Prospective randomized study.
Setting: Medical intensive care unit of a tertiary medical center.
Patients: Four hundred sixty-three mechanically ventilated patients
enrolled in a randomized controlled ISRCTN-registered trial
(ISRCTN-61258470).
Interventions: We compared the ultrasound-guided subclavian vein
cannulation (200 patients) vs. the landmark method (201 patients) using
an infraclavicular needle insertion point in all cases. Catheterization
was performed under nonemergency conditions in the intensive care unit.
Randomization was performed by means of a computer-generated
random-numbers table and patients were stratified with regard to age,
gender, and body mass index.
Measurements and Main 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. In this study, the real-time ultrasound method was rated
on a semiquantitative scale as technically difficult by the
participating physicians.
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. (Crit Care Med 2011; 39: 1607-1612
