Supraclavicular or infraclavicular subclavian vein: Which way to go- A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance

BACKGROUND AND AIMS: Subclavian vein (SCV) catheterization via the supraclavicular (SSV) or infraclavicular (ISV) approaches under real time ultrasonographic (USG) guidance is being performed routinely in critically ill patients in ICU.The aim of this study is comparative evaluation of SSV and ISV approaches in terms of success rate, time taken and incidence of complications. SETTINGS AND DESIGN: In this prospective study, 110 critically ill patients were randomly divided into two groups of 55 each. Right SCV catheterization was performed using real time USG by single experienced operator. METHODS: Success rate, first attempt success rate, time taken for venous visualization, puncture, catheterization, total procedure, incidence of mechanical, and infectious complications were variables used for comparison among groups. STATISTICAL ANALYSIS USED: Normality tests were performed using the Kolmogorov-Smirnov test. All data are expressed as the mean (SD), number (%), or median [interquartile range (IQR)] as indicated. Data were compared using the χ(2) test, the Mann–Whitney U-test, Fisher's exact test and Student's t-test as appropriate. RESULTS: Total procedural time was significantly lesser in SSV group than ISV group (P < 0.0001). Time for visualization, puncture and catheterization were significantly higher in ISV group (P < 0.001). Success rate was 100% in both groups. First attempt success rate was more in SSV (P = 0.171).Two incidence of malposition was found in ISV group. Infectious complications were comparable in both groups. CONCLUSIONS: Real time USG-guided supraclavicular subclavian approach is a viable and preferable alternative with significantly lesser total procedural time, similar success rate, fewer attempts, faster and lesser complication rates as compared with infraclavicular approach.