Effectiveness of Ultrasonography Guided Subclavian Catheterization

Background: Central venous catheterization (CVC) insertion is a prevalent invasive procedure performed in critical care patients. Although this procedure is considered to provide better patient comfort and a lower infection risk compared to other methods, it has a higher risk of complications, such as pneumothorax, arterial puncture, nerve injury, and bleeding. Ultrasonography (USG)-guided subclavian catheterization has recently become a popular technique. This study retrospectively analyzed 50 patients in the intensive care unit (ICU) who underwent infraclavicular subclavian catheterization with the out-of-plane technique under USG guidance. Objectives: This study aimed to evaluate the effectiveness of subclavian catheterization applied with the out-of-plane technique in the ICU. Methods: This retrospective study included 50 patients who underwent subclavian CVC insertion via the out-of-plane technique under USG guidance in the ICU between March and December 2020. Age, gender, height, weight, body mass index, admission to the ICU, use of anticoagulant and/or anti-aggregant medicine, and coagulation parameters were recorded for each patient. The success of the procedure, the number of attempts, and the duration of the procedure were scanned retrospectively from the records. Malposition and complications were monitored using USG throughout the procedure and chest radiographs after the procedure. Results: The 50 patients comprised 27 (54%) men and 23 (46%) women, with a mean age of 72.8 +/- 11.8 years. In all patients, subclavian CVC insertion was successfully performed under USG guidance via the out-of-plane technique. The mean procedural time was 220.90 +/- 60.20 sec. The procedure was completed in a single session for 27 (54%), two sessions for 22 (44%), and three sessions for 1 (2%) patient. Only one complication (pneumothorax) developed in one patient, who underwent tube thoracostomy. No catheter malposition was observed in other patients. Conclusion: USG-guided subclavian catheterization is a safe technique to be performed by experienced practitioners.