Comparison of ultrasound-guided internal jugular vein and supraclavicular subclavian vein catheterization in critically ill patients: a prospective, randomized clinical trial

Becem Trabelsi, Zied Hajjej, Dhouha Drira, Azza Yedes, Iheb Labbene, Mustapha Ferjani, Mechaal Ben Ali, Becem Trabelsi, Zied Hajjej, Dhouha Drira, Azza Yedes, Iheb Labbene, Mustapha Ferjani, Mechaal Ben Ali

Abstract

Background: The aim of this study was to compare the effectiveness and safety of ultrasound-guided out-of-plane internal jugular vein (OOP-IJV) and in-plane supraclavicular subclavian vein (IP-SSCV) catheterization in adult intensive care unit.

Methods: A total of 250 consecutive patients requiring central venous catheterization, were randomly assigned to undergo either ultrasound-guided OOP-IJV or IP-SSCV cannulation. All catheterizations were carried out by three physicians. The primary outcome was the first attempt success rate. Ultrasound scanning time, venous puncture time, insertion time, overall access time, number of puncture attempts, number of needle redirections, success rate, guidewire advancing difficulties, venous collapse and adverse events were also documented.

Results: The first attempt success rate was significantly higher in IP-SSCV group (83.2%) compared to OOP-IJV group (63.2%) (p = 0.001). The IP-SSCV group was associated with a longer ultrasound scanning time (16.54 ± 13.51 vs. 5.26 ± 4.05 s; p < 0.001) and a shorter insertion time (43.98 ± 26.77 vs. 53.12 ± 40.21 s; p = 0.038). In the IP-SCCV group, we recorded a fewer number of puncture attempts (1.16 ± 0.39 vs. 1.47 ± 0.71; p < 0.001), needle redirections (0.69 ± 0.58 vs. 1.17 ± 0.95; p < 0.001), difficulties in guidewire advancement (2.4% vs. 27.4%; p < 0.001), venous collapse (2.4%, vs. 18.4%; p < 0.001) and adverse events (8.8% vs. 13.6%; p = 0.22).

Conclusions: The IP-SSCV approach is an effective and a safe alternative to the classic OOP-IJV catheterization in critical adult patients.

Trial registration: Clinicaltrials.gov, NCT03879954. Registered March 19, 2019-Retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT03879954 .

Keywords: Central venous cannulation; Internal jugular vein; Scanning axis; Subclavian vein; Supraclavicular approach; Ultrasound guidance.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Ultrasound-guided IJV catheterization using the short-axis view of the vein in combination with out-of-plane needle approach. a Ultrasound visualization of IJV and CCA. b Ultrasound visualization of the guidewire in the IJV. IJV internal jugular vein, CCA common carotid artery, SCM sternocleidomastoid muscle
Fig. 2
Fig. 2
Ultrasound-guided subclavian vein catheterization using the long-axis view of the vein via the supraclavicular approach in combination with in-plane needle approach. a Ultrasound short-axis view of IJV. b Ultrasound identification of IJV and SCA in the supraclavicular fossa. c Ultrasound long-axis view of SCV and BCV. d Ultrasound visualization of the guidewire in the SCV. SCV subclavian vein, SCA subclavian artery, BCV brachiocephalic vein, ITA internal thoracic artery, Asterisk acoustic shadow of the 1st rib
Fig. 3
Fig. 3
CONSORT flow diagram of the study. OOP-IJV out-of-plane internal jugular vein, IP-SSCV in-plane supraclavicular subclavian vein

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