The real effectiveness of ultrasound guidance in subclavian venous access

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COD: 331-334-1 Categorie: ,

Marco Milone, Giovanni Di Minno, Matteo Nicola Dario Di Minno, Giuseppe Salvatore, Carmine Iacovazzo, Carmela Policastro, Francesco Milone

Ann. Ital. Chir., 2010 81: 331-334

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AIM: The technique of ultrasound-guided subclavian cannulation was evaluated in our experience assessing the real effectiveness
of such procedure.
METHODS: We have evaluated 297 subclavian cannulation, performed for the placement of central venous catheter both
with landmark method (176 patients) and ultrasound guided technique (121 patients) to assess the real effectiveness of
the ultrasound-guided technique to reduce the mechanical complication of the subclavian vein puncture.
RESULTS: A total of 23 mechanical complications were identified. Of these, 8 were pneumothorax and 15 arterial puncture.
Such cases were identified from the pool of patients who had undergone subclavian venous cannulation with landmark
method. However these complications occurred only in difficult venous access and teaching procedure performed
with landmark method.
DISCUSSION: An ultrasound-guided recent technique for the placement of central venous access should be adopted since
such technique seems to reduce the incidence of failure and mechanical complications. However it is worth notice that
the clinical effect of using ultrasound guidance technique seems to be more significant when the internal jugular vein
rather than the subclavian vein is cannulated.
CONCLUSION: Our experience demonstrate that, both in no difficult cases and in no teaching procedures, central venous
catheterization using landmark technique seems to be acceptable on both clinical and medico-legal grounds. However the
ultrasound guided technique is necessarily required to achieve the reduction of complications in difficult venous access.

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