Comparative study of ultrasound-guided in-plane and anatomical landmark cannulation of infraclavicular subclavian vein in intensive care unit – a prospective randomized control trial.

Lathika G; Elakkiya.G; Rajaram M; Panneerselvam  Periasamy

doi:10.51168/sjhrafrica.v6i6.1945

Authors

Dr. Lathika G Assistant Professor, Department of Anaesthesiology, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India, under The Tamil Nadu Dr. M.G.R. Medical University, Chennai
Dr. Elakkiya.G Assistant Surgeon, Department of Anaesthesiology, Government Hospital, Kattumannarkoil, Tamil Nadu, India, under The Tamil Nadu Dr. M.G.R. Medical University, Chennai.
Dr. Rajaram M Senior Resident, Department of Anaesthesiology, Government Hospital, Ulundurpet, Kallakurichi, Tamil Nadu, India, under The Tamil Nadu Dr. M.G.R. Medical University, Chennai.
Dr.Panneerselvam Periasamy Assistant Professor, Department of Physiology, Government Erode Medical College, Perundurai, Tamil Nadu, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1945

Keywords:

Subclavian vein cannulation, Ultrasound guidance, Anatomical landmark technique, Central venous catheterization, Intensive care unit, Vascular access

Abstract

Background: Subclavian vein cannulation is a critical procedure in the intensive care unit (ICU) for administering medications, fluids, and hemodynamic monitoring. Traditional anatomical landmark techniques, while widely practiced, are associated with higher complication rates. The use of ultrasound-guided techniques has emerged as a safer alternative with improved success rates.

Objectives: To compare ultrasound-guided in-plane cannulation and anatomical landmark cannulation of the infraclavicular subclavian vein in terms of success rates, complication rates, procedural time, and hemodynamic changes in ICU patients.

Materials and methods: This prospective randomized controlled trial included 60 ICU patients requiring subclavian vein cannulation, who were randomly assigned to two groups: Group U (ultrasound-guided, n=30) and Group L (landmark-guided, n=30). Primary outcomes included time to locate the subclavian vein and the number of attempts. Secondary outcomes were success rate, failure rate, complications, and hemodynamic changes. Data were analyzed using appropriate statistical tests.

Results: The groups were comparable in baseline demographics. The mean time to locate the vein was 4.0 ± 1.0 minutes in Group U and 4.2 ± 1.0 minutes in Group L (p = 0.44). The success rate was higher in Group U (87%) compared to Group L (85%), while the corresponding failure rates were 13% and 15% respectively, though differences were not statistically significant (p = 0.59). Complications were slightly lower in the ultrasound group (18%) versus the landmark group (20%) (p = 0.72). Heart rate changes post-cannulation remained stable in both groups, with a significant difference noted only at 5 minutes (p = 0.05).

Conclusion: Ultrasound-guided in-plane subclavian vein cannulation demonstrates slightly higher success rates, fewer complications, and comparable procedural time, confirming its clinical advantage over the anatomical landmark technique in ICU settings.

Recommendations: Ultrasound-guided subclavian vein cannulation should be routinely implemented in ICUs to enhance safety, procedural success, and patient outcomes.

Author Biographies

Dr. Lathika G, Assistant Professor, Department of Anaesthesiology, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India, under The Tamil Nadu Dr. M.G.R. Medical University, Chennai

is currently serving as an Assistant Surgeon in the Department of Anesthesiology at Kattumannarkoil Government Hospital, under the Tamil Nadu Dr. M.G.R. Medical University, Chennai. She earned her M.B.B.S. from Government Erode Medical College (2013–2019) and recently completed her M.D. in Anaesthesiology at Government Mohan Kumaramangalam Medical College, Salem (2022–2025). With one year of clinical experience, Dr. Elakkiya is developing her expertise in anaesthetic practice with a focus on patient safety and perioperative care. ORCID iD: 0009-0004-7805-7952

Dr. Elakkiya.G, Assistant Surgeon, Department of Anaesthesiology, Government Hospital, Kattumannarkoil, Tamil Nadu, India, under The Tamil Nadu Dr. M.G.R. Medical University, Chennai.

is currently serving as an Assistant Surgeon in the Department of Anesthesiology at Kattumannarkoil Government Hospital, under the Tamil Nadu Dr. M.G.R. Medical University, Chennai. She earned her M.B.B.S. from Government Erode Medical College (2013–2019) and recently completed her M.D. in Anaesthesiology at Government Mohan Kumaramangalam Medical College, Salem (2022–2025). With one year of clinical experience, Dr. Elakkiya is developing her expertise in anaesthetic practice with a focus on patient safety and perioperative care. ORCID iD: 0009-0004-7805-7952

Dr. Rajaram M, Senior Resident, Department of Anaesthesiology, Government Hospital, Ulundurpet, Kallakurichi, Tamil Nadu, India, under The Tamil Nadu Dr. M.G.R. Medical University, Chennai.

is currently working as a Senior Resident in the Department of Anaesthesia at Government Hospital, Ulundurpet, Kallakurichi District, affiliated with The Tamil Nadu Dr. M.G.R. Medical University, Chennai. He holds an M.B.B.S. degree from K.A.P. Viswanatham Government Medical College, Tiruchirapalli (2013–2019), and recently completed his M.D. in Anaesthesiology at Government Mohan Kumaramangalam Medical College, Salem (2022–2025). With a growing interest in clinical anaesthesia and perioperative care, Dr. Rajaram is in the early stages of his medical career and brings a committed and evidence-based approach to patient care. ORCID iD: 0009-0000-8041-5502

Dr.Panneerselvam Periasamy, Assistant Professor, Department of Physiology, Government Erode Medical College, Perundurai, Tamil Nadu, India.

is an Assistant Professor of Physiology at Government Erode Medical College, Tamil Nadu, with over 22 years of experience in medical education and research. He holds a Ph.D. in Medical Physiology from Vinayaka Missions Research Foundation Deemed to be University (VMRF-DU), an M.Sc. from Kasturba Medical College (MAHE), and an M.A. in Yoga for Human Excellence from Bharathiar University. His doctoral work explored the physiological and psychological effects of Simplified Kundalini Yoga (SKY) on moderately stressed students. He has published over 125 peer-reviewed articles, with research interests focusing on stress physiology, yoga, and integrative medical education. He is also actively involved in academic administration and faculty development. ORCID iD: https://orcid.org/0000-0002-3358-313X

References

Zawadka M, La Via L, Wong A, Olusanya O, Muscarà L, Continella C, Andruszkiewicz P, Sanfilippo F. Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis. Crit Care Med. 2023 May 1;51(5):642-652. doi: 10.1097/CCM.0000000000005819. Epub 2023 Mar 2. PMID: 36861982. https://doi.org/10.1097/CCM.0000000000005819

Zarskus A, Zykutė D, Trepenaitis D, Macas A. Implementation of Ultrasound-Guided Infraclavicular Subclavian Venous Catheterization During Anesthesia and Elective Surgery: A Prospective Observational Study at a Single Center in Lithuania. Med Sci Monit. 2023 Jan 11;29:e938851. doi: 10.12659/MSM.938851. PMID: 36627833; PMCID: PMC9844010. https://doi.org/10.12659/MSM.938851

Sidoti A, Brogi E, Biancofiore G, Casagli S, Guarracino F, Malacarne P, Tollapi L, Borselli M, Santori G, Corradi F, Forfori F. Ultrasound- versus landmark-guided subclavian vein catheterization: a prospective observational study from a tertiary referral hospital. Sci Rep. 2019 Aug 22;9(1):12248. doi: 10.1038/s41598-019-48766-1. PMID: 31439913; PMCID: PMC6706444. https://doi.org/10.1038/s41598-019-48766-1

Weiner MM, Geldard P, Mittnacht AJ. Ultrasound-guided vascular access: a comprehensive review. J Cardiothorac Vasc Anesth. 2013 Apr;27(2):345-60. doi: 10.1053/j.jvca.2012.07.007. Epub 2012 Sep 18. PMID: 22995457. https://doi.org/10.1053/j.jvca.2012.07.007

Imai E, Watanabe J, Okano H, Yokozuka M. Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterisation: An updated systematic review and meta-analysis of randomised controlled trials. Indian J Anaesth. 2023 Jun;67(6):486-496. doi: 10.4103/ija.ija_837_22. Epub 2023 Jun 14. PMID: 37476443; PMCID: PMC10355348. https://doi.org/10.4103/ija.ija_837_22

Reusz G, Csomos A. The role of ultrasound guidance for vascular access. Curr Opin Anaesthesiol. 2015 Dec;28(6):710-6. doi: 10.1097/ACO.0000000000000245. PMID: 26539789. https://doi.org/10.1097/ACO.0000000000000245

Kumar A, Sinha C, Kumar A, Kumari P, Singh K, Sinha AK. Comparison between in-plane and out-of-plane techniques for ultrasound-guided cannulation of the left brachiocephalic vein in pediatric population: A randomised controlled trial. Anaesth Crit Care Pain Med. 2023 Oct;42(5):101247. doi: 10.1016/j.accpm.2023.101247. Epub 2023 May 19. PMID: 37211216. https://doi.org/10.1016/j.accpm.2023.101247

Keenan SP. Use of ultrasound to place central lines. J Crit Care. 2002 Jun;17(2):126-37. doi: 10.1053/jcrc.2002.34364. PMID: 12096376. https://doi.org/10.1053/jcrc.2002.34364

Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017 Aug 28;21(1):225. doi: 10.1186/s13054-017-1814-y. PMID: 28844205; PMCID: PMC5572160. https://doi.org/10.1186/s13054-017-1814-y

Sazdov D, Srceva MJ, Todorova ZN. Comparative Analysis of Ultrasound-Guided Central Venous Catheterization Compared to Blind Catheterization. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2017 Sep 1;38(2):107-114. doi: 10.1515/prilozi-2017-0028. PMID: 28991766. https://doi.org/10.1515/prilozi-2017-0028

Wagner M, Hauser K, Cardona F, Schmölzer GM, Berger A, Olischar M, Werther T. Implementation and Evaluation of Training for Ultrasound-Guided Vascular Access to Small Vessels Using a Low-Cost Cadaver Model. Pediatr Crit Care Med. 2018 Nov;19(11):e611-e617. Doi: 10.1097/PCC.0000000000001721. PMID: 30234738. https://doi.org/10.1097/PCC.0000000000001721

Taylor RW, Palagiri AV. Central venous catheterization. Crit Care Med. 2007 May;35(5):1390-6. doi: 10.1097/01.CCM.0000260241.80346.1B. PMID: 17414086. https://doi.org/10.1097/01.CCM.0000260241.80346.1B