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A randomized clinical trial of ultrasound-guided infra-clavicular cannulation of the subclavian vein in cardiac surgical patients: short-axis versus long-axis approach

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Abstract

Purpose

The aim of this study was to compare the success rate and safety of short-axis versus long-axis approaches to ultrasound-guided subclavian vein cannulation.

Methods

A total of 190 patients requiring central venous cannulation following cardiac surgery were randomized to either short-axis or long-axis ultrasound-guided cannulation of the subclavian vein. Each cannulation was performed by anesthesiologists with at least 3 years’ experience of ultrasound-guided central vein cannulation (>150 procedures/year, 50% short-axis and 50% long-axis). Success rate, insertion time, number of needle redirections, number of separate skin or vessel punctures, rate of mechanical complications, catheter misplacements, and incidence of central line-associated bloodstream infection were documented for each procedure.

Results

The subclavian vein was successfully cannulated in all 190 patients. The mean insertion time was significantly shorter (p = 0.040) in the short-axis group (69 ± 74 s) than in the long-axis group (98 ± 103 s). The short-axis group was also associated with a higher overall success rate (96 vs. 78%, p < 0.001), first-puncture success rate (86 vs. 67%, p = 0.003), and first-puncture single-pass success rate (72 vs. 48%, p = 0.002), and with fewer needle redirections (0.39 ± 0.88 vs. 0.88 ± 1.15, p = 0.001), skin punctures (1.12 ± 0.38 vs. 1.28 ± 0.54, p = 0.019), and complications (3 vs. 13%, p = 0.028).

Conclusions

The short-axis procedure for ultrasound-guided subclavian cannulation offers advantages over the long-axis approach in cardiac surgery patients.

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Acknowledgement

We thank Professor Vito Brusasco for help in the final editing of the manuscript.

Author contributions

Drs Vezzani, Corradi, and Brusasco contributed to study design, data collection and analysis, and the writing of the manuscript, and are the guarantors of the paper; Dr Ramelli contributed to data collection, data analysis, and reading and checking of the manuscript; Drs Santori, Cantadori, and Gonzi contributed to data analysis, statistical revision, and reading and checking of the manuscript; Drs Nicolini and Manca contributed to organization of the study, patient selection, and data collection; Dr Gherli contributed to data analysis and reading and checking of the manuscript.

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Authors and Affiliations

  1. Department of Surgery, University Hospital of Parma, Parma, Italy

    Antonella Vezzani, Tullio Manca, Andrea Ramelli, Francesco Nicolini & Tiziano Gherli

  2. Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Mura Della Cappuccine 14, 16128, Genoa, Italy

    Claudia Brusasco & Francesco Corradi

  3. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy

    Gregorio Santori

  4. Department of Emergency Medicine, Fidenza Hospital, AUSL of Parma, Parma, Italy

    Luca Cantadori

  5. Department of Cardiology, University Hospital of Parma, Parma, Italy

    Gianluca Gonzi

Authors
  1. Antonella Vezzani
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  2. Tullio Manca
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  3. Claudia Brusasco
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  4. Gregorio Santori
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  5. Luca Cantadori
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  6. Andrea Ramelli
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  7. Gianluca Gonzi
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  8. Francesco Nicolini
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  9. Tiziano Gherli
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  10. Francesco Corradi
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Corresponding author

Correspondence to Francesco Corradi.

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Conflicts of interest

None for all authors.

Additional information

Some preliminary results of this study were reported in abstract form at the 34th International Symposium on Intensive Care and Emergency Medicine. [Corradi F, Brusasco C, Cocconcelli F, Agostinelli A, Benassi F, Gherli T, Vezzani A (2014) Real-time ultrasound-guided subclavian vein cannulation in cardiac surgery: comparison between short-axis and long-axis techniques. Critical Care 18(Suppl 1): p 132].

Take-home message

Central venous cannulation of the subclavian vein is an important tool in the postoperative treatment of cardiac patients, and there is general consensus on the advantage of using ultrasound for vascular access. The short-axis procedure is associated with a higher success rate, shorter procedure time, and fewer needle redirections and complications than the long-axis approach.

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Vezzani, A., Manca, T., Brusasco, C. et al. A randomized clinical trial of ultrasound-guided infra-clavicular cannulation of the subclavian vein in cardiac surgical patients: short-axis versus long-axis approach. Intensive Care Med 43, 1594–1601 (2017). https://doi.org/10.1007/s00134-017-4756-6

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  • DOI: https://doi.org/10.1007/s00134-017-4756-6

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