Comparison of a novel anterior out-of-plane approach with standard in-plane approach in ultrasound-guided supraclavicular subclavian vein cannulation: A randomised controlled trial

• 發表在: Indian Journal of Anaesthesia
• Main Authors: Nikkila Mai Nandagopan, VK Mohan, Adethen Gunasekaran, Rajasekar Ramadurai, Prasanna U. Bidkar
• 格式: Article
• 語言: 英语
• 出版: Wolters Kluwer Medknow Publications 2025-10-01
• 主題: anterior out-of-plane technique; arterial puncture; central venous cannulation; sonography; subclavian vein; supraclavicular subclavian vein
• 在線閱讀: https://journals.lww.com/10.4103/ija.ija_615_25
• ISSN: 0019-5049; 0976-2817

Background and Aims: Subclavian vein cannulation is a commonly performed procedure in the operating room. Ultrasound-guided supraclavicular subclavian vein cannulation can be done using either an in-plane or out-of-plane approach. This study compares the in-plane technique with a novel anterior out-of-plane technique. The primary objective of the study was to compare the first-pass success rate between the anterior out-of-plane technique approach and the in-plane approach for ultrasound-guided subclavian vein cannulation. Methods: This single-centre, open-label, randomised controlled trial included 128 patients undergoing elective surgeries that required central vein cannulation. Patients were randomised to either the anterior out-of-plane or in-plane technique for ultrasound-guided subclavian central venous access. First-pass success rates, puncture and cannulation times, needle redirections, additional punctures, and complications were recorded and compared between groups. Continuous variables were analysed using independent-sample t-tests, and categorical variables with Chi-square tests. Normality was confirmed by the Shapiro–Wilk test; P values < 0.05 were considered statistically significant. Results: Successful cannulation was achieved in 119 patients. The first-pass success rate was significantly higher with the anterior out-of-plane approach (95%) compared to the in-plane approach (77%) (P < 0.05). The out-of-plane approach demonstrated shorter puncture [9 (SD: 3) seconds] and cannulation times [148 (SD: 31) seconds) compared to the in-plane approach [17 (SD: 9) seconds and 185 (SD: 32) seconds, respectively]. Additionally, fewer needle redirections, punctures, and complications, including arterial punctures (1 vs 5), were observed with the out-of-plane approach. Conclusion: Ultrasound-guided supraclavicular subclavian vein cannulation is more successful and efficient using this novel anterior out-of-plane approach compared to the standard in-plane approach.