Ultrasound-Guided vs. Landmark Method for Subclavian Vein Catheterization in an Academic Emergency Department

Background: Ultrasound guidance has been shown to decrease complication rates and improve success for internal jugular and femoral vein catheterization in the emergency department (ED). However, the current data on the efficacy and safety of ultrasound-guided subclavian vein catheterization has failed to provide support for similar conclusions. Objective: To determine if ultrasound-guided subclavian vein catheterization is safer and more efficacious than the traditional landmark method in an ED setting. Methods: A prospective randomized trial was conducted from April 2004 through June 2009 in an urban tertiary care academic ED with an annual census of >50,000 patients. Four primary data endpoints were calculated: 1) overall success for both resident and attending physicians; 2) number of attempts by each group of providers; 3) complication rate with each method; and 4) time to which the subclavian line was obtained. Results: Eighty-five patients were enrolled in the study. The ultrasound method was more successful in obtaining subclavian catheter placement when compared with the landmark method. When comparing successful cannulation attempts in both groups, the ultrasound group showed a statistically significant longer time to success when compared with the landmark group. There was no difference in the success or complication rates between residents and attending physicians. There was no significant difference in complications rates between ultrasound-guided and landmark methods. Conclusion: Ultrasound-guided subclavian vein catheterization was found to be associated with a higher overall success rate compared with the landmark method with no significant difference with respect to complication rate in an ED setting. (c) 2022 Elsevier Inc. (c) 2021 Elsevier Inc. All rights reserved.