Ultrasound-Guided In-Plane Subclavian Vein Puncture versus Prior Ultrasound and Landmark Technique: A Randomized...

Area of Science:

• Medical Procedures
• Ultrasound Guidance
• Vascular Access

Background:

• Central venous catheterization (CVC) of the subclavian vein is a common medical procedure.
• Ultrasound guidance is increasingly recommended for CVC to enhance success rates and minimize complications.
• This study evaluates ultrasound-guided microconvex in-plane subclavian puncture (MISP) against the traditional landmark technique.

Purpose of the Study:

• To compare the efficacy and safety of ultrasound-guided MISP versus the landmark technique for subclavian vein catheterization.
• To assess a composite risk score encompassing various puncture-related complications.
• To determine differences in success rates, complication profiles, and procedural times between the two techniques.

Main Methods:

• A randomized controlled trial involving 101 patients undergoing elective surgery.
• Patients were randomized to either the MISP group or the control (landmark) group after an initial ultrasound prescan.
• The primary endpoint was a composite risk score; secondary endpoints included success and complication rates.

Main Results:

• The MISP group exhibited a significantly lower composite risk score (6.4 ± 5.9) compared to the control group (11.6 ± 10.8).
• Ultrasound-guided MISP showed significantly higher success rates (86%) and reduced arterial puncture risk (1.9%) versus the landmark technique (71% and 12%, respectively).
• Procedural time was longer in the MISP group (mean difference of 5 minutes), but complication rates were significantly lower.

Conclusions:

• Ultrasound-guided MISP significantly decreases complication risks associated with subclavian vein catheterization compared to the landmark method.
• The observed reduction in complications may outweigh the increase in procedural time.
• Further research is recommended to establish MISP as a standard CVC approach.