Ultrasound Better Than Landmark Guidance for Subclavian Vein Cannulation

In a direct comparison, ultrasound guidance was faster, more successful, and associated with fewer complications.

Ultrasound-guided procedures are becoming increasingly common in the emergency department, but do they improve outcomes? Investigators in Greece prospectively randomized 463 sedated and ventilated intensive care unit patients to undergo infraclavicular subclavian vein cannulation guided by real-time ultrasound or the landmark method; 62 patients in the landmark group were converted to the ultrasound group because of technical difficulties and were excluded.


Ultrasound guidance was associated with a significantly higher success rate (100% vs. 88%), shorter access time (mean, 27 vs. 45 seconds), and fewer attempts (mean, 1.1 vs. 1.9). Complications were significantly more frequent in the landmark group (10 pneumothoraces, 9 hemothoraces, 6 brachial plexus injuries, 3 phrenic nerve injuries, and 1 cardiac tamponade) than in the ultrasound group (none). Physicians who performed the procedures (all of whom had at least 6 years of experience in subclavian vein cannulation) rated the ultrasound-guided procedure as technically complex (mean score of 8 on a complexity scale of 0 to 10). Although the incidence of catheter misplacement was similar between the ultrasound and landmark groups (about 10%), ultrasound permitted immediate repositioning.


Citation(s):

Fragou M et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study. Crit Care Med 2011 Jul; 39:1607.[e-pub ahead of print]