SUBCLAVIAN VENOUS CATHETERIZATION - GREATER SUCCESS RATE FOR LESS EXPERIENCED OPERATORS USING ULTRASOUND GUIDANCE

Objective: To determine if ultrasound guidance can be safely performed and improve success rates for subclavian venous catheterization perfo rmed by less experienced operators. Design: Prospective, randomized st udy. Setting: Twenty-bed trauma-surgical-medical intensive care unit i n a 524-bed, community, tertiary care, teaching hospital. Patients: Af ter the decision for central venous cannulation was made, informed con sent was obtained, and less experienced operators then attempted to in sert subclavian catheters in 33 critical care patients. Interventions: Catheter placements were attempted, either by landmark technique, ult rasound technique, or by landmark attempts with ultrasound salvage, Ca theterization techniques to be used were randomized using a random num ber table.Measurements and Main Results: Fifty-three placement procedu res were attempted in 33 patients. One procedure was excluded from dat a analysis, Successful catheterizations, occurrence rates of complicat ions, number of attempts, and number of catheter kits used were record ed, In the analysis, 52 catheterization procedures were studied, Twelv e (44%) catheters were successfully placed from 27 attempts using the landmark technique vs, 23 (92%) successful catheterizations during 25 ultrasound procedures (p = .0003), Fifteen failed landmark technique a ttempts had ultrasound salvage attempted, with 12 (80%) catheters succ essfully inserted, Eleven complications (minor) occurred in 27 attempt s of subclavian venous catheterization using conventional landmark tec hnique vs, one complication (minor) in 25 attempts of subclavian venou s catheterization with ultrasound guidance (p = .002), There were no m ajor complications in either group, The landmark group required an ave rage of 2.5 venipunctures and 1.4 catheter kits per attempted catheter ization, The ultrasound group required an average of 1.4 venipuncture attempts and 1.0 insertion kit. The statistical significance in differ ences in groups for the average number of venipunctures was p = .0007 and average number of kits used was p = .0003. Conclusions: Ultrasound guidance improves the success rate of subclavian venous catheterizati on performed by less experienced operators. There were no major compli cations in either group. Ultrasound guidance is usually successful in allowing performance of subclavian venous catheterizations when landma rk techniques fail.