Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Coronary Artery Bypass Graft

Percutaneous central vein catheterization is one of the most invasive procedures commonly performed by anesthesiologists during cardiac surgery.
The aim of this study was to investigate the complications of supraclavicular (SC) versus infraclavicular (IC) approaches for subclavian vein catheterization during coronary artery bypass graft surgery.
Between October 2014 and June 2015, this prospective, randomized clinical trial was performed in 280 patients. The patients were randomly cannulated by SC or IC approach. The success and complication rates were compared for the two approaches. The outcome of this study was analyzed using SPSS software and through Chi-square test.
In the first attempt of catheterization, the success rate in SC (78.6%) group was lower than IC (94.3%) group (P = 0.0001). The overall success rate in two attempts were 136 (97.1%) in the IC approach and 132 (94.3%) in the SC approach (P = 0.238). In 12 (4.3%) patients, subclavian catheterizations were failed after two attempts in both approaches. In 28 (10%) patients, hematoma at puncture site occurred, 1 (0.7%) in IC approach, and 27 (19.3%) in SC approach (P = 0.0001). The differences in other complications on two approaches were statistically insignificant.
Compared with the SC approach, the IC approach resulted in fewer hematomas at puncture sites. The incidence of overall cannulation failure and other complications were similar on both approaches.