UMEM Educational Pearls

Prior literature has demonstrated the safety and feasibility of placing subclavian lines with ultrasound guidance; here's a link to a short educational video describing the technique. 

The literature has been varied, however, as to which approach is best for venous cannulation with ultrasound; the supraclavicular (SC) or infraclavicular (IC) approach (see references below)

A recent study evaluated both approaches in healthy volunteers in order to determine which approach is superior for cannulation using ultrasound.

98 patients were prospective evaluated by Emergency Medicine physicians with training in ultrasound. In each patient, both SC and IC views were evaluated on both the left and right sides; each view was given a grade for ease of favorability (no patients were actually cannulated)

Overall, it was found that the SC view was significantly more favorable compared to the IC view; the right SC was non-significantly preferred compared to the left SC.


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Stachura, M. et al. A Comparison of the Supraclavicular and Infraclavicular Views for Imaging the Subclavian Vein with Ultrasound. The American Journal of Emergency Medicine (in press) 

Fragou, M., Gravvanis, A., and Vasilios, D. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study. Crit Care Med. 2011; 39: 1607–1612

Mallin, M., Louis, H., and Madsen, T. A novel technique for ultrasound-guided supraclavicular subclavian cannulation. Am J Emerg Med. 2010; 28: 966–969

Czarnik, T., Gawda, R., Perkowski, T. et al. Supraclavicular approach is an easy and safe method of subclavian vein catheterization even in mechanically ventilated patients. analysis of 370 attempts. Anesthesiology. 2009; 111:334–339