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Updated: May 10, 2026
The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire
Published on: December 23, 2014
Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous
1Department of Anesthesiology and Pain Medicine, Inha University Hospital, Incheon, Republic of Korea.
Insights
The supraclavicular approach for ultrasound-guided subclavian vein catheterization in children is faster and safer than the infraclavicular approach, reducing guidewire misplacement. This improves pediatric central venous access procedures.
Area of Science:
- Pediatric Anesthesiology
- Vascular Access Procedures
- Medical Imaging
Background:
- Ultrasound-guided subclavian vein catheterization is a common procedure in pediatric patients.
- Two primary approaches exist: supraclavicular (SC) and infraclavicular (IC).
- Comparing the efficacy of these SCV catheterization techniques is crucial for optimizing patient care.
Purpose of the Study:
- To prospectively compare the efficacy of the supraclavicular (SC) versus infraclavicular (IC) approaches for ultrasound-guided subclavian vein catheterization in children.
- To evaluate key procedural metrics including puncture time, number of attempts, and complication rates.
Main Methods:
- A prospective, randomized study involving 98 pediatric patients (<3 years old) undergoing SCV catheterization.
- Patients were divided into two groups: SC (n=49) and IC (n=49).
- All procedures were ultrasound-guided and performed by an experienced anesthesiologist, with data on time, attempts, guidewire insertion, catheter insertion, and complications collected.
Main Results:
- The infraclavicular (IC) approach had a significantly longer median puncture time (48s vs 36s) and required more attempts (>3) compared to the supraclavicular (SC) approach (24.5% vs 6.1%).
- Guidewire misplacement occurred more frequently in the IC group (20.4%) than the SC group (0%).
- Successful catheterization was achieved in all patients, with no pneumothoraces or arterial punctures in either group.
Conclusions:
- The supraclavicular (SC) approach for ultrasound-guided subclavian vein catheterization in pediatric patients is associated with shorter puncture times.
- The SC approach significantly reduces the incidence of guidewire misplacement compared to the infraclavicular (IC) approach.
- These findings suggest the SC approach offers improved efficacy and safety for pediatric subclavian vein access.
Background:
Ultrasound (US)-guided subclavian vein (SCV) catheterization via the supraclavicular (SC) or infraclavicular (IC) approaches can be useful in children. The purpose of this study was to compare the efficacy of these approaches.
Methods:
This prospective, randomized study included 98 children who were <3 years old, and who were divided into two groups: the SC group (n=49) and the IC group (n=49). All SCV catheterizations were guided by US and performed by a single experienced anaesthesiologist. Data regarding puncture time, number of attempts, successful guidewire insertion, catheter insertion time, and complications were analysed.
Results:
The median puncture time was longer in the IC group than the SC group (48 vs 36 s, P=0.02). Multiple attempts (number of attempts >3) were more frequently required in the IC group than the SC group (24.5 vs 6.1%, P=0.01). The incidence of guidewire misplacement was higher in the IC group than that of the SC group [10 (20.4%) vs 0 (0%), P=0.001]. Catheterization was successfully performed in all patients. No pneumothoraces or arterial punctures occurred in either group.
Conclusion:
During SCV catheterization under US guidance in paediatric patients, the SC approach yielded a shorter puncture time and decreased the incidence of guidewire misplacement when compared with the IC approach.
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