PULSED DOPPLER ULTRASONOGRAPHY GUIDANCE FOR CATHETERIZATION OF THE SUBCLAVIAN VEIN - A RANDOMIZED STUDY

Background: Catheterization of the subclavian vein may lead to severe complications. The current randomized study compared a technique of pu lsed Doppler ultrasonography guidance and the standard method for subc lavian vein catheterization. Methods: Standard and Doppler ultrasonogr aphy guidance methods were performed by the same physician in 286 pati ents, 143 in each group, Primary end points were immediate complicatio ns (arterial puncture, pneumothorax, wrong position of catheter tip), failures, the number of subclavian vein catheterizations with immediat e complication or failure, the number of skin punctures per catheteriz ation, and the time to placement of the guide mire. The secondary end points were the determination of predicting factors of successful cann ulation in each group. Results: Both groups were similar according to morphologic parameters of the patients, A greater number of subclavian vein catheterizations were performed on the right side using Doppler guidance (105 vs. 73, P < 0.01), Doppler guidance decreased complicati ons (5.6% vs. 16.8%, P < 0.01), largely because of a smaller number of catheters for which the tip was defined to be in incorrect position ( 0.7% vs. 7.7%, P < 0.01). The time to catheterization was longer with Doppler guidance (300 vs. 27 s, P < 0.001). Failures, catheterizations of the subclavian vein with immediate complications or failure, and t he total number of skin punctures per catheterization were similar in both groups. Using Doppler guidance, the presence of a good Doppler si gnal (124 of 143) was predictive of successful catheterization (123 su ccessful cannulations, P < 0.001). Conclusions: Doppler guidance reduc es the incidence of inappropriately positioned subclavian catheters.