PROSPECTIVE, RANDOMIZED TRIAL OF DOPPLER-ASSISTED SUBCLAVIAN VEIN CATHETERIZATION

Objective: To examine the rate of success and complications of Doppler -guided subclavian vein catheter insertion compared with standard inse rtion in patients considered at high risk for failure. Design: Prospec tive, randomized, crossover trial. Setting: University-affiliated tert iary care medical center. Patients: Two hundred forty patients were en rolled in the study. Patients were stratified for 3 known risk factors : (1) prior surgery in the subclavian vein region, (2) prior radiother apy at the attempted catheterization site, and (3) an abnormal weight- height ratio. Interventions: Subclavian vein catheterization was perfo rmed either in standard or Doppler-guided fashion using the Smart Need le (Peripheral Systems Group, Mountain View, Calif), which is a Dopple r probe at the tip of a cannulating needle. If subclavian vein cathete rization was unsuccessful after 2 attempts, patients were crossed over to the other technique. Main Outcome Measure: Successful cannulation of the subclavian vein. Results: The success rate, either as an initia l technique or as a technique, and complication rate were not signific antly different with use of the Smart Needle. A subgroup of physicians had a significantly lower success rate using the Smart Needle. Conclu sions: Doppler guidance did not increase the success rate or decrease the complication rate of subclavian vein catheterization when compared with the standard technique in high-risk patients. Doppler guidance w as not more useful than the standard technique as a salvage technique following a previous failure of catheterization. Furthermore, real-tim e Doppler guidance of subclavian vein catheterization is a technique t hat is highly operator dependent.