Supraclavicular vs Infraclavicular Subclavian Lines
Mar 14, 2022
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The podcast discusses the comparison between supraclavicular and infraclavicular approaches for ultrasound-guided subclavian venous catheterization. It includes experiences, opinions, a study on complication rates, and the importance of using ultrasound guidance. A study comparing two techniques for subclavian lines is also discussed, focusing on safety, complications, patient conditions, and trial results. Results of a study show a higher rate of complications with the infraclavicular approach. Techniques for subclavian lines placement and safety outcomes of different ultrasound-guided central lines are also highlighted.
Ultrasound-guided superclavicular approach for subclavian venous catheterization has lower complication rates and higher success rates for cannulation.
Further research is needed to determine the generalizability of the findings to other patient populations.
Deep dives
Erector Spinae Plane Block for Rib Fractures
A case series study examined the efficacy of the erector spinae plane block for managing acute pain in emergency department patients with rib fractures. The study involved nine patients who received diluted bupivacaine and experienced significant pain reduction. This pilot study suggests that the erector spinae plane block could be a beneficial option for patients with intractable pain from rib fractures.
Comparison of Ultrasound-Guided Central Line Approaches
A randomized controlled non-inferiority trial compared the superclavicular and infraclavicular approaches for ultrasound-guided subclavian venous catheterization. The study included 401 adult patients undergoing elective neurosurgery. The results indicated that the superclavicular approach had a lower complication rate (3% vs. 13.4%) and higher success rates for cannulation. However, it is important to note that this was a specific patient population, and more research is needed to determine the generalizability of these findings to other settings and patient populations.
Limitations and Implications
While the study provides valuable insights into the safety and efficacy of ultrasound-guided subclavian central lines, there were several limitations. The composite endpoint used for complications may have obscured the differences in misplacements and mechanical complications. Additionally, the study's non-inferiority design limits the conclusion to the superclavicular approach being non-inferior to infraclavicular, rather than superior. More diverse patient populations and settings should be considered in future research to further explore these techniques.
Ultrasound has been a friend to central venous catheter placement for a long time. It's always there to make sure you are putting that line in the right place without causing problems. While this has been standard for internal jugular lines for years, it is only more recently that this has been proposed for subclavian lines. There is now ample literature supporting this latter practice, although as far as I know, it is not yet widely adopted. This article starts off with the assumption that ultrasound is being used for subclavian lines and now asks the question, which is the safer approach - above or below the clavicle?