Influence of Cannulation Point on Infraclavicular Subclavian Vein Catheterization: A Clinical Trial

BACKGROUND: Choosing a proper approach to subclavian vein cannulation is a challenge for physicians. However, percutaneous infraclavicular subclavian vein cannulation is now an acceptable technique. OBJECTIVES: The present study was performed to compare the success rate and complications of subclavian vein cannulation using the midpoint technique and the lateral technique. METHODS: In this prospective randomized clinical trial, we randomly assigned 440 patients undergoing subclavian vein cannulation to either midpoint approach or lateral approach groups from April 2018 to February 2019. The complications and success rates of catheterization were compared between the two approaches. The data were analyzed using SPSS software (version 20). RESULTS: Unlike the first attempt of catheterization, the success rate was significantly higher in the midpoint technique (75 %) than in lateral technique (39%) in the second attempt (P = 0.003). The overall success rates were 96.8% and 88.6% in the midpoint approach and lateral approach, respectively. A significant difference was observed between the two techniques in the overall success rate (P = 0.001). Inadvertent subclavian artery puncture occurred in 26 (5.9%) patients including 3 (1.4%) patients in the midpoint technique and 23 (10.5%) patients in the lateral technique. In 19 (4.3%) patients, malposition of the catheter tip occurred, including 14 (6.4%) in the midpoint approach and 5 (2.3%) in the lateral approach. There was a significant difference between the two approaches in malposition and subclavian artery puncture (P = 0.035 and P = 0.0001, respectively). There were no significant differences between the two techniques in other complications. CONCLUSIONS: This investigation showed that the midpoint approach was more appropriate than the lateral approach for infraclavicular subclavian vein catheterization with landmark-based techniques.