- Compared with anatomic landmark guidance, static ultrasound assistance is associated with better success and fewer complications in placing subclavian central line.
Why this matters
- The subclavian location is preferred for central lines in the critical care setting, offering easier care and less infection risk.
- But placement success rates can be low, and complications, e.g., pneumothorax, arterial mispuncture, are common.
- Dynamic, direct, real-time ultrasound guidance, although important in internal jugular and femoral venous cannulation, can result in a mispunctured axillary vein when used during subclavian placement.
- This article evaluated the static, indirect, or ultrasound-assisted method, sometimes called ultrasonic landmark-guided puncture.
- This method is nonsterile and uses ultrasound to mark point of entry on the skin.
- Ultrasound- vs anatomic landmark-guided approach:
- Successful puncture rate: 91.7% vs 77.6% (P=.007).
- Complications: 7.3% vs 20.4% (P=.008).
- Mispuncture of artery: 2.1% vs 14.3% (P=.002).
- First-attempt success, number of punctures, procedure duration: no significant between-group differences.
- Pilot randomized controlled trial (n=194).
- Critically ill adults were randomly assigned to ultrasound-guided vs anatomical landmark-guided subclavian central line placement.
- Outcome: successful puncture (
- Funding: Science and Technology Bureau, Jiaxing, Zhejiang, China.
- Single-center study.
- Did not compare dynamic to static techniques.