SUPRACLAVICULAR APPROACH TO SUBCLAVIAN CATHETERIZATION - REVIEW OF THE LITERATURE AND RESULTS OF 178 ATTEMPTS BY THE SAME OPERATOR

Over a period of 15 months, 178 consecutive attempts at supraclavicula r catheterization of the subclavian veins were performed by the same o perator, There were 42 additional central lines inserted during this p eriod, which were placed via other methods as specified by the attendi ng physicians, Results of the supraclavicular approach are presented a nd are believed to be the largest reported series of supraclavicular l ine insertions by one operator, Forty-five of the supraclavicular line s were placed after failed attempts by other emergency room and surgic al physicians, Five were inserted in patients that were in hypovolemic shock, and three were placed in morbidly obese patients weighing 800, 400, and 335 pounds, Of the 178 attempts, there was only one signific ant complication: a left-sided pneumothorax on the 21st attempt in an emphysematous patient, The vein was successfully accessed in 177 cases with only two instances of inability to thread the catheter and one i nstance of malposition, Overall, there was satisfactory placement in 9 7.8% of attempts with a significant complication rate of 0.56%, This p aper intends to describe the details of subclavian venipuncture by the supraclavicular technique, and, because of the high degree of reliabi lity and safety of this technique in experienced hands, to recommend i t as an excellent alternative for central venous access -especially in difficult cases.