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Cureus 2022 Apr 4;14(4):e23823. Epub 2022 Apr 4.

Anesthesiology, University of Florida, Gainesville, USA.

Introduction The supraclavicular approach to the subclavian vein has been cited as having many advantages to the infraclavicular approach, including a larger short-axis cross-sectional area, a greater margin of safety, and fewer complications. Methods To examine whether a larger short-axis cross-sectional area of the subclavian vein at the supraclavicular fossa is a potential explanation for the reduction in attempts with the supraclavicular approach seen in a previous study, we examined computed tomography scans from 50 patients (24 M, 26 F). The short-axis cross-sectional areas of the subclavian vein at the mid-clavicular line, the subclavian vein in the supraclavicular fossa, and the internal jugular vein at the level of the thyroid cartilage were calculated. Read More

Cureus 2022 Apr 3;14(4):e23781. Epub 2022 Apr 3.

Internal Medicine, Ibn e Sina Hospital, Kabul, AFG.

Central venous catheterization plays a key role in patients that require immediate resuscitation, long-term fluid management, and invasive monitoring. The supraclavicular (SC) and infraclavicular (IC) approaches are utilized for central venous catheterization and both have their benefits and limitations. In this systematic review, we aim to explore the success rate and various complications of the SC technique. Read More

Anaesthesia 2022 01 6;77(1):59-65. Epub 2021 Jul 6.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

Infraclavicular and supraclavicular approaches are used for subclavian venous catheterisation. We hypothesised that the supraclavicular approach is non-inferior to the infraclavicular approach in terms of safety during ultrasound-guided right subclavian venous catheterisation. We randomly allocated 401 neurosurgical patients undergoing ultrasound-guided right subclavian venous catheterisation into supraclavicular (n = 200) and infraclavicular (n = 201) groups. Read More

J Vasc Access 2022 May 1;23(3):474-476. Epub 2021 Mar 1.

Department of Anesthesiology and Operative Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany.

Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications. Read More

J Cancer Res Ther 2020 ;16(7):1575-1581

Department of Interventional Radiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Provinece, China.

Background: The background of this study was to explore the success rate and early complications concerning the implantation of totally implantable venous access devices (TIVADs) by percutaneous venipuncture and management strategies for early complications.

Materials And Methods: This was a retrospective study of 1923 patients who received TIVAD implantation by percutaneous venipuncture (mostly via the supraclavicular route). The percutaneous access sites were internal jugular vein (810 patients; right/left: 158/652) or proximal right internal jugular vein, brachiocephalic vein, and proximal subclavian vein (1113 patients). Read More

Paediatr Anaesth 2021 03 27;31(3):346-351. Epub 2021 Jan 27.

Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.

Background: Methods to determine the optimal insertion depth of ultrasound-guided supraclavicular approach to the subclavian vein (SCV) catheterization, alternatively used for central venous access, are debatable in children.

Aim: We investigated the applicability and reliability of the modified formula for determining the depth of SCV catheterization using an ultrasound-guided supraclavicular approach in children.

Methods: This prospective observational study included 36 children (age <6 years; weight ≥5 kg) scheduled to undergo congenital heart disease surgery. Read More

PLoS One 2020 24;15(11):e0242727. Epub 2020 Nov 24.

Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco.

Introduction: The insertion of an implantable central venous access is performed according to a variety of approaches which allow the access to the subclavian vein, yet the supraclavicular technique has been underused and never compared to the other methods. The aim of this study was to testify on the efficacy and safety of the subclavian puncture without ultrasound guidance « Yoffa » in comparison with the classical infraclavicular approach (ICA).

Material And Methods: This is a retrospective study with prospective data collection on patients followed at the national oncology institute for cancer, in the period extending from May 1st 2017 to August 31st 2017. Read More

Ann Intensive Care 2020 Sep 7;10(1):118. Epub 2020 Sep 7.

Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France.

The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections' prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Read More

Paediatr Anaesth 2020 08 25;30(8):928-933. Epub 2020 Jun 25.

Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria.

Background: The aim of this retrospective analysis was to evaluate the clinical feasibility of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in infants weighing less than 1500 g.

Methods: The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long-axis view of the brachiocephalic vein. By using an in-plane approach the brachiocephalic vein was cannulated by using a 24-gauge intravenous cannula under real-time ultrasound guidance into the vein followed by the insertion of a 2-French single lumen catheter using the Seldinger technique. Read More

Am J Emerg Med 2020 07 8;38(7):1475-1480. Epub 2020 Apr 8.

Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute/Chongqing Cancer Hospital, China. Electronic address:

Background: In this meta-analysis, we investigated the success rate of subclavian venous catheterization (SVC) as well as the incidence of related complications when performed via the supraclavicular (SC) or traditional infraclavicular (IC) approaches.

Methods: Ignoring the original language, we identified and analyzed eight randomized controlled trials (RCTs) published on or before December 30, 2018, after searching the following five bibliographic databases: PubMed, Springer, Medline, EMBASE, and the Cochrane Library. All included studies compared the clinical safety and efficiency of the SC and IC approaches for SVC in adults. Read More

J Vasc Access 2020 Mar 6;21(2):241-245. Epub 2019 Sep 6.

Department of Anesthesiology and Pain Medicine, Kutahya Health Sciences University Hospital, Kutahya, Turkey.

Central venous catheterization of children is often a challenging procedure due to small anatomical structures. Ultrasound guidance has been shown to reduce complications and improve cannulation success as compared with the landmark-based technique. In-plane techniques allow for longitudinal visualization of the vessels and real-time visualization of needle track during its advancement. Read More

J Pediatr Surg 2020 Jun 9;55(6):1157-1161. Epub 2019 Dec 9.

Department of Pediatric Anesthesiology, University Hospital Bonn, Bonn, Germany.

Background: Tunneled Hickman/Broviac central venous catheter implantation is performed when patients require a central vein route for long-term therapy. The subclavian or internal jugular vein approach is often chosen for their implantation sites. However, access to the central vein can be difficult owing to thrombosis or stenosis when the same vein has already been accessed several times. Read More

Cureus 2019 Aug 21;11(8):e5452. Epub 2019 Aug 21.

Medicine, Zia Hospital, Sadiqabad, PAK.

Introduction: Peripheral intravenous cannulation (PIVC) is a universal procedure to get venous access in hospital emergency settings. Sometimes, for critically ill patients in an emergency department, when we cannot get peripheral venous access, a central venous access could be established by percutaneous subclavian vein cannula insertion through a supraclavicular approach. This study will compare PIVC and percutaneous subclavian vein cannula insertion through supraclavicular approach, and determine which method is more effective and fast in critically ill patients arriving in the emergency department. Read More

Pol Przegl Chir 2019 Jun;91(4):19-23

Department of Surgery, Medical University, Pleven, Bulgarian.

Purpose: Insertion of temporary and tunneled catheters for hemodialysis in the internal jugular vein is a "gold standard". On the other hand, the supraclavicular approach to the subclavian vein was described by Yoffa in 1965. Despite its old invention, the latter technique has been well forgotten for unknown reasons. Read More

Mil Med 2019 03;184(Suppl 1):329-334

Department of Anesthesiology, 1600 SW Archer Road, Gainesville, FL.

In a study with 76 anesthesia providers on a mixed reality simulator, central venous access via the supraclavicular approach to the subclavian vein, without ultrasonography required less attempts compared to the infraclavicular approach. Participants had shorter times to venous access and larger improvements in confidence. Results from this simulation-based study indicate that the supraclavicular approach may deserve consideration as an alternative approach for central venous access in deployed military environments. Read More

Anesth Essays Res 2018 Oct-Dec;12(4):873-878

Department of Anesthesia, Fayoum University, Faiyum, Egypt.

Background: Vascular access is a top priority in the critically ill patients. Cannulation - venous and/or arterial - is the first step in any emergency situation. Ultrasound (US)-guided vascular cannulation was found to have a higher success rate and a decreased incidence of mechanical complications as compared with the landmark one. Read More

Anesth Analg 2018 07;127(1):83-89

From the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.

Background: We investigated whether visual augmentation (3D, real-time, color visualization) of a procedural simulator improved performance during training in the supraclavicular approach to the subclavian vein, not as widely known or used as its infraclavicular counterpart.

Methods: To train anesthesiology residents to access a central vein, a mixed reality simulator with emulated ultrasound imaging was created using an anatomically authentic, 3D-printed, physical mannequin based on a computed tomographic scan of an actual human. The simulator has a corresponding 3D virtual model of the neck and upper chest anatomy. Read More

Front Pediatr 2017 5;5:211. Epub 2017 Oct 5.

Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France.

The correct choice of intra vascular access in critically ill neonates should be individualized depending on the type and duration of therapy, gestational and chronological age, weight and/or size, diagnosis, clinical status, and venous system patency. Accordingly, there is an ongoing demand for optimization of catheterization. Recently, the use of ultrasound (US)-guided cannulation of the subclavian vein (SCV) has been described in children and neonates. Read More

Pediatr Crit Care Med 2017 02;18(2):172-175

1Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, Paris, France. 2School of Medicine, Paris South University, Le Kremlin-Bicêtre, Paris, France. 3Institute of Integrative Biology of the Cell-UMR 9198, Paris Saclay University, Gif-sur-Yvette, Paris, France. 4Espace Ethique/IDF, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.

Objectives: Central venous access in critically ill, small infants remains technically challenging even in experienced hands. Several vascular accesses exist, but the subclavian vein is often preferred for central venous catheter insertion in infants where abdominal malformation and/or closure of the vein preclude the use of umbilical venous catheters, as catheterization of the subclavian vein is easier in very short necks than the internal jugular vein for age-related anatomical reasons. The subclavian vein approach is yet relatively undescribed in low birth weight infants (i. Read More

Crit Ultrasound J 2016 Sep;8(Suppl 1):12

Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.

Table Of Contents: A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Read More

Am J Emerg Med 2016 Sep 7;34(9):1761-4. Epub 2016 Jun 7.

Department of Emergency Medicine, University of California Irvine, Irvine, California.

Background: Point-of-care ultrasound guidance using a linear probe is well established as a tool to increase safety when performing a supradiaphragmatic cannulation of the internal jugular central vein. However, little data exist on which probe is best for performing a supradiaphragmatic cannulation of the subclavian vein.

Methods: This was a prospective, observational study at a single-site emergency department, where 5 different physician sonologists evaluate individual practice preference for visualization of the subclavian vein using a supraclavicular approach with 2 different linear probes and 1 endocavitary probe. Read More

J Vasc Access 2016 Sep 22;17(5):435-9. Epub 2016 Mar 22.

Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn - Germany.

Purpose: The ultrasound-guided central venous catheter (CVC) guidewire tip positioning has been demonstrated for catheterization of the right internal jugular vein. We explored the feasibility of an ultrasound-guided right subclavian vein (RScV) CVC tip positioning via a right supraclavicular approach using a microconvex probe.

Methods: Twenty patients scheduled for elective surgery were consecutively included in this observational feasibility study following written informed consent. Read More

Indian J Crit Care Med 2013 Jan;17(1):10-5

Department of Anesthesia and Intensive Care, St. Stephen's Hospital, Tis Hazari, New Delhi, India.

The supraclavicular approach was first put into clinical practice in 1965 by Yoffa and is an underused method for gaining central access. It offers several advantages over the conventional infraclavicular approach to the subclavian vein. At the insertion site, the subclavian vein is closer to the skin, and the right-sided approach offers a straighter path into the subclavian vein. Read More

J Vasc Access 2013 Jan-Mar;14(1):89-93. Epub 2012 Jul 23.

School of Anesthesia and Intensive Care Medicine, University of Pisa, Pisa, Italy.

Purpose: Ultrasound-guided (USG) central vein cannulation has become very popular among anesthesiologists and critical care physicians in the last decade and it has been advocated as the gold standard practice for internal jugular vein (IJV) catheterization.

Methods: We report a technique used at our second level hospital for cannulating either subclavian vein or innominate vein using a supraclavicular (SCV) approach under real time ultrasound guidance for elective positioning of long, medium or short-term central venous catheters (CVC). We report one year of practice. Read More

Paediatr Anaesth 2011 Nov 1;21(11):1136-41. Epub 2011 Jun 1.

Department of Anesthesiology, Hôpital mère enfant, 69500 Bron, France.

Background: Ultrasound (US) guidance techniques are reported to be safe for internal jugular vein catheterization, although anatomic conditions are not favorable for this approach in infants. The subclavian vein (SCV) seems to be a better site for long-term central venous catheterization in children, with a supraclavicular approach to avoid compression of the central venous catheter between the clavicle and the first rib ('pinch-off' syndrome). We describe a new US-guided approach for supraclavicular SCV cannulation in infants. Read More

J Cardiothorac Vasc Anesth 2011 Dec 7;25(6):1018-23. Epub 2011 Apr 7.

Department of Anesthesiology and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey.

Objective: To evaluate the clinical success rate, safety, and usefulness for intraoperative central venous pressure monitoring, and the intravenous access of the supraclavicular subclavian vein approach when compared with the infraclavicular subclavian vein approach and the internal jugular vein approach for central venous catheterization during open-chest cardiac surgery.

Design: A prospective, randomized, single-center study.

Setting: A university hospital. Read More

Anesthesiology 2009 Aug;111(2):334-9

Department of Anesthesia and Critical Care, Regional Medical Centre, Opole, Poland.

Background: Central venous catheters are commonly inserted for hemodynamic monitoring, volume monitoring, administration of medications, long-term total parenteral nutrition, access for renal replacement therapy, cardiopulmonary resuscitation, and difficult peripheral catheterization. The primary outcome of this study was to define venipuncture, catheterization and entire procedure success rates, and finally complication rate of subclavian venous catheterization via the supraclavicular approach with special focus on mechanically ventilated patients. The secondary outcome was to potentially make recommendations regarding this technique of central venous catheterization in mechanically ventilated patients. Read More

Curr Opin Organ Transplant 2009 Jun;14(3):281-5

Department of Anaesthesiology and Reanimation, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain.

Purpose Of Review: Central venous catheterization (CVC) is a procedure, not exempt of risk. Transplantation patients represent by themselves a high-risk group for CVC. Ultrasonography provides us of the exact localization of the target vein and its relationship with artery and nerve structures, detecting anatomic variations and thromboses of vessels. Read More

Semin Dial 2008 Sep-Oct;21(5):469-73. Epub 2008 Aug 29.

Department of Anesthesiology, Taipei-Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC.

Background: Because of overuse and multiple implantations of hemodialysis catheters through internal jugular or subclavian vein (SCV) in patients with chronic hemodialysis, these veins often become stenotic or occlude, therefore necessitating alternative access. We introduce a new technique in ventilated patients for placement of tunneled cuffed chronic hemodialysis catheter: modified supraclavicular approach by cease of ventilation.

Methods: Patients who received implantation of the tunneled cuffed chronic hemodialysis catheters by supraclavicular approach were collected from February 2003 to July 2005. Read More

J Vasc Access 2000 Jul-Sep;1(3):100-7

Departments of Surgery and Oncology, Catholic University, Rome - Italy.

There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent in-sertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein. Read More