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Intensive Care Med. 2017 Nov;43(11):1594-1601. doi: 10.1007/s00134-017-4756-6. Epub 2017 Mar 13.

A randomized clinical trial of ultrasound-guided infra-clavicular cannulation of the subclavian vein in cardiac surgical patients: short-axis versus long-axis approach.

Author information

1
Department of Surgery, University Hospital of Parma, Parma, Italy.
2
Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Mura Della Cappuccine 14, 16128, Genoa, Italy.
3
Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
4
Department of Emergency Medicine, Fidenza Hospital, AUSL of Parma, Parma, Italy.
5
Department of Cardiology, University Hospital of Parma, Parma, Italy.
6
Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Mura Della Cappuccine 14, 16128, Genoa, Italy. francescorradi@gmail.com.

Abstract

PURPOSE:

The aim of this study was to compare the success rate and safety of short-axis versus long-axis approaches to ultrasound-guided subclavian vein cannulation.

METHODS:

A total of 190 patients requiring central venous cannulation following cardiac surgery were randomized to either short-axis or long-axis ultrasound-guided cannulation of the subclavian vein. Each cannulation was performed by anesthesiologists with at least 3 years' experience of ultrasound-guided central vein cannulation (>150 procedures/year, 50% short-axis and 50% long-axis). Success rate, insertion time, number of needle redirections, number of separate skin or vessel punctures, rate of mechanical complications, catheter misplacements, and incidence of central line-associated bloodstream infection were documented for each procedure.

RESULTS:

The subclavian vein was successfully cannulated in all 190 patients. The mean insertion time was significantly shorter (p = 0.040) in the short-axis group (69 ± 74 s) than in the long-axis group (98 ± 103 s). The short-axis group was also associated with a higher overall success rate (96 vs. 78%, p < 0.001), first-puncture success rate (86 vs. 67%, p = 0.003), and first-puncture single-pass success rate (72 vs. 48%, p = 0.002), and with fewer needle redirections (0.39 ± 0.88 vs. 0.88 ± 1.15, p = 0.001), skin punctures (1.12 ± 0.38 vs. 1.28 ± 0.54, p = 0.019), and complications (3 vs. 13%, p = 0.028).

CONCLUSIONS:

The short-axis procedure for ultrasound-guided subclavian cannulation offers advantages over the long-axis approach in cardiac surgery patients.

KEYWORDS:

Central venous cannulation; Scanning axis; Subclavian vein; Ultrasound

PMID:
28289815
DOI:
10.1007/s00134-017-4756-6
[Indexed for MEDLINE]

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