What is the role of ultrasonographic (US) guidance 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

To date, ultrasonographic (US) guidance [14] has mainly been used in a "mark and go" fashion to identify insertion points. So used, it may not improve the overall success rate of placement as it does for both femoral and internal jugular vessels. However, one study suggested that real-time US guidance in sedated and ventilated patients was useful for the subclavian approach in the hands of experienced operators. [11]

Senussi et al, with the aim of reducing the risk of mechanical complications attendant on central venous cannulation via the subclavian approach, reviewed a method that potentially affords increased safety and allows avoidance of pneumothorax during US-guided subclavian vein cannulation. [15] In this method, the needle is directed toward the subclavian vein at a point where it passes over the second rib. This offers a margin of safety by providing a protective rib shield between vessel and pleura; it also renders the vein more readily compressible in the event of a bleeding complication.


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