Subclavian Central Venous Catheters and Ultrasound Guidance: Policy vs Practice

• Published in: The journal of vascular access Vol. 14; no. 2; pp. 104 - 110
• Main Authors: Griswold-Theodorson, Sharon, Farabaugh, Eric, Handly, Neal, McGrath, Todd, Wagner, David
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-04-2013
• Subjects: Anatomic Landmarks; Arteries - injuries; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Catheters, Indwelling; Central Venous Catheters; Chi-Square Distribution; Clinical Competence; Cross-Over Studies; Humans; Learning Curve; Manikins; Philadelphia; Prospective Studies; Punctures; Students, Medical; Subclavian Vein - diagnostic imaging; Time Factors; Ultrasonography, Interventional - adverse effects; Vascular System Injuries - etiology; Vascular System Injuries - prevention & control; Subclavian vein; Central venous catheter; Simulation model; Internal jugular vein; Ultrasound guidance
• ISSN: 1129-7298; 1724-6032
• DOI: 10.5301/jva.5000112

Purpose
Policy statements recommend the use of ultrasound guidance (USG) to improve patient safety during placement of central venous catheters (CVCs). Studies have conclusively demonstrated greater success rates and fewer complications with the use of USG in catheter placement using the internal jugular vein approach. Data supporting the use of USG for the subclavian vein (SCV) approach, however, have been less conclusive, and USG for SCV cannulation is rarely used in clinical practice. We compared USG placement versus anatomic placement during subclavian insertion of a CVC.
Methods
A prospective randomized study was performed in March 2010 using a simulation model.
Results
Ultrasound guidance did not provide a statistically significant benefit for successful cannulation of the SCV (93.3% with USG and 100% without; P=0.15 or 2) or for rate of inadvertent arterial puncture (3.3% with USG and 0% without; P=0.31).
Conclusions
The use of USG to access the SCV utilizing a task trainer did not improve time to cannulation or success rates. Further study is required to delineate why USG for SCV cannulation has not been widely adopted in clinical practice.