Real-time in-plane ultrasound-guided supraclavicular approach to subclavian vein cannulation in cardiac surgery: An underused approach

Background
Although the subclavian vein has several anatomical advantages; it has been underused in cardiac surgery. In this feasibility study, the author aimed to test real-time in-plane ultrasound-guided supraclavicular subclavian vein cannulation during elective cardiac surgical procedures as an acceptable alternative for the routinely used internal jugular vein.
Methods
This prospective feasibility study included forty adult patients undergoing elective on-pump cardiac surgical procedures performed during the period from June 2012 to January 2013. The aim of this study is to test real-time in-plane ultrasound-guided supraclavicular subclavian vein cannulation in terms of time of placement, number of attempts to puncture the vein, inadvertent arterial puncture, usability before and after sternal retractor expansion, and catheter tip position.
Results
Successful cannulation of the subclavian vein was accomplished in an average time of 43.8 (14.9) s. The median number of skin punctures was 1 (range 1–3). All lumens of the catheters were usable both before and after using the sternal retractor in all cases except one. The central venous pressure waveform has been recorded in all cases except one. Using transesophageal echocardiography all catheter tips were found to lie within 1.6 cm from the crista terminalis.
Conclusion
Real-time in-plane ultrasound-guided supraclavicular subclavian vein cannulation is an easy and safe approach to be used in adult patients undergoing cardiac surgical procedures.