Static ultrasound assistance eases subclavian vein puncture


  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • Single-center study.
  • Did not compare dynamic to static techniques.