What is the role of ultrasonography in central venous access via the subclavian vein?

Updated: Aug 07, 2018
  • Author: E Jedd Roe, lll, MD, MBA, FACEP, FAAEM, MSF, CPE; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

The advent of bedside ultrasonography (US) has changed the overall technique of the placement of central venous catheters in both the internal jugular vein and the femoral vein. However, the use of this modality for subclavian routes has been infrequently studied, though there are some reports suggesting that it is feasible and safe.

Because of the anatomy of the subclavian approach, there is little room to effectively position the transducer while manipulating the needle. With the advent of newer transducers, however, reports are emerging of effective US-guided techniques. [9]  Compared with the studies evaluating the internal jugular approach, the studies evaluating US-guided approaches to the subclavian vein are fewer in number and lower in quality; nevertheless, their results are encouraging with respect to patient safety and quality. [10, 11]

The physician’s experience and comfort level with the procedure, however, are the main determinants as to the success of the line placement in cases with no other patient-related factors that may increase the incidence of complications.


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