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Prospective, randomized trial of Doppler-assisted subclavian vein catheterization
R J Bold1, D J Winchester, A R Madary
1Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Objective:
To examine the rate of success and complications of Doppler-guided subclavian vein catheter insertion compared with standard insertion in patients considered at high risk for failure.
Design:
Prospective, randomized, crossover trial.
Setting:
University-affiliated tertiary care medical center.
Patients:
Two hundred forty patients were enrolled in the study. Patients were stratified for 3 known risk factors: (1) prior surgery in the subclavian vein region, (2) prior radiotherapy at the attempted catheterization site, and (3) an abnormal weight-height ratio.
Interventions:
Subclavian vein catheterization was performed either in standard or Doppler-guided fashion using the Smart Needle (Peripheral Systems Group, Mountain View, Calif), which is a Doppler probe at the tip of a cannulating needle. If subclavian vein catheterization was unsuccessful after 2 attempts, patients were crossed over to the other technique.
Main Outcome Measure:
Successful cannulation of the subclavian vein.
Results:
The success rate, either as an initial technique or as a salvage technique, and complication rate were not significantly different with use of the Smart Needle. A subgroup of physicians had a significantly lower success rate using the Smart Needle.
Conclusions:
Doppler guidance did not increase the success rate or decrease the complication rate of subclavian vein catheterization when compared with the standard technique in high-risk patients. Doppler guidance was not more useful than the standard technique as a salvage technique following a previous failure of catheterization. Furthermore, real-time Doppler guidance of subclavian vein catheterization is a technique that is highly operator dependent.