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Published on: January 13, 2026
Limiting vein puncture to three needle passes in subclavian vein catheterization by the infraclavicular approach
Hiromitsu Takeyama1, Masaaki Taniguchi, Hirozumi Sawai
1Department of Gastroenterological Surgery, Nagoya City University, Graduate School of Medical Sciences, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan.
Insights
Limiting subclavian vein catheterization to three needle passes significantly reduced complications. A lower body mass index was associated with a higher risk of vein puncture failure in this study.
Area of Science:
- Medical Procedures
- Vascular Access
- Patient Safety
Background:
- Central venous catheterization is essential but carries risks with each additional vein puncture.
- Complications from central venous catheterization can be serious and impact patient outcomes.
Purpose of the Study:
- To assess the failure and complication rates of subclavian vein catheterization when limiting needle passes to three.
- To identify factors associated with vein puncture failure during subclavian catheterization.
Main Methods:
- A prospective clinical trial involving 232 adult patients undergoing non-emergency subclavian vein catheterization.
- Right subclavian vein catheterization performed via the infraclavicular approach.
- Failure defined as inability to achieve venipuncture after three attempts or any arterial puncture.
Main Results:
- Vein puncture failure occurred in 3.9% of patients, with 0.9% resulting in arterial puncture.
- No other mechanical complications like pneumothorax or air embolism were observed.
- A body mass index close to average was associated with a reduced risk of failure (OR 0.74, P=0.028).
Conclusions:
- Restricting needle passes to three for subclavian vein catheterization appears to prevent mechanical complications.
- A low body mass index is a predictive factor for vein puncture failure in this procedure.
Purpose:
With central venous catheterization, each additional vein puncture raises the risk of complications. We assessed the rate of failure and complications using a limiting rule whereby the number of needle passes for subclavian vein catheterization was restricted to three.
Methods:
A prospective clinical trial was conducted between September 2001 and December 2003 in a university hospital surgical department. Two hundred and thirty-two adult patients were enrolled to undergo subclavian vein catheterization under non-emergency conditions. The patients were subjected to right subclavian vein catheterization by the infraclavicular approach. Vein puncture failure was defined as such if venipuncture was not accomplished after three attempts. Any arterial puncture was judged to be a failure immediately.
Results:
Vein puncture failure occurred in nine patients (3.9%), and included two arterial punctures (0.9%). No other complications, such as pneumothorax, hemothorax, plexus lesion, mediastinal hematoma or bleeding, or air embolism, were observed. In multivariate analyses, a close to average body mass index (weight in kilograms divided by the square of the height in meters, odds ratio 0.74; 95% confidence interval 0.56-0.97; P = 0.028) was associated with a low risk of failure.
Conclusion:
Limiting the number of needle passes to three may therefore prevent mechanical complications. A low body mass index was predictive of vein puncture failure.
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