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Abstract：
Background Ultrasound-guided subclavian vein catheterization is crucial for central venous access, but the choice between the supraclavicular and infraclavicular approaches lacks comprehensive comparison. This study addresses this gap by conducting a prospective observational analysis of both techniques. The supraclavicular method accesses the vein from above the clavicle while the infraclavicular targets it below. Our model-driven approach aims to elucidate the procedural nuances, success rates, and complications associated with each method. The findings intend to equip clinicians with evidence-based insights, facilitating informed decision-making for improved procedural outcomes in ultrasound-guided subclavian vein catheterization. Aim and objective This study aims to comprehensively compare the supraclavicular and infraclavicular approaches in ultrasound-guided subclavian vein catheterization, evaluating the procedural minutiae, potential advantages, and challenges associated with each technique. Employing a prospective observational methodology, our objective is to provide evidence-based insights for approaches in ultrasound-guided subclavian vein catheterization, evaluating procedural nuances, success rates, and complications during the procedure. Methods In this prospective investigation, 276 patients aged between 20 and 55 years were randomly assigned to two groups: 143 patients in the supraclavicular group and 133 patients in the infraclavicular group. Specifically, patients admitted for elective surgery necessitating postoperative ICU care were considered. The study assessed various variables, including success rate, time required for venous visualization, venous puncture, catheterization, total procedure duration, and incidence of mechanical complications, to facilitate group comparisons. Results The mean procedural time was shorter in the supraclavicular group compared to the infraclavicular group, with durations of 2 minutes and 2 seconds versus 3 minutes and 40 seconds, respectively (95% CI). This difference was statistically significant. Similarly, the mean durations for venous visualization, venous puncture, and venous catheterization were also shorter in the supraclavicular group, and these differences were statistically significant. Both groups achieved a 100% success rate, with the first attempt success rate being higher in the supraclavicular subclavian vein group. Conclusion The findings of this study demonstrate a statistically significant advantage in favor of the supraclavicular approach for ultrasound-guided subclavian vein catheterization. The shorter mean procedural time, as well as durations for venous visualization, puncture, and catheterization, emphasize the efficiency of the supraclavicular technique. The consistently achieved 100% success rate, coupled with a higher first-attempt success rate, further underscores the proficiency of the supraclavicular subclavian vein group. These results collectively suggest that the supraclavicular approach is not only time-efficient but also superior in terms of successful central line placement, making it a promising choice for both emergency and critical care settings.
摘要：
背景超声引导锁骨下静脉置管对于中心静脉通路至关重要,但是锁骨上入路和锁骨下入路的选择缺乏综合比较。本研究通过对这两种技术进行前瞻性观察分析来解决这一差距。锁骨上方法从锁骨上方进入静脉，而锁骨下将其定位在下方。我们的模型驱动方法旨在阐明程序上的细微差别，成功率,以及与每种方法相关的并发症。这些发现旨在为临床医生提供基于证据的见解，在超声引导下锁骨下静脉置管中,促进知情决策,以改善手术结局.目的与目的本研究旨在综合比较超声引导锁骨下静脉置管的锁骨上和锁骨下入路,评估程序细节，潜在优势,以及与每种技术相关的挑战。采用前瞻性观察方法，我们的目标是为超声引导锁骨下静脉置管的方法提供循证见解,评估程序上的细微差别，成功率,以及手术过程中的并发症。方法在这项前瞻性调查中，276例年龄在20至55岁之间的患者被随机分为两组：锁骨上组143例患者和锁骨下组133例患者。具体来说,考虑了需要术后ICU护理的择期手术患者.这项研究评估了各种变量，包括成功率，静脉可视化所需的时间，静脉穿刺,导管插入术,手术总持续时间,和机械并发症的发生率，以方便小组比较。结果锁骨上组平均手术时间短于锁骨下组,持续时间为2分2秒，而持续时间为3分40秒，分别（95%CI）。这种差异具有统计学意义。同样，静脉可视化的平均持续时间，静脉穿刺,锁骨上组的静脉置管也较短，这些差异具有统计学意义。两组均取得了100%的成功率,锁骨上锁骨下静脉组首次尝试成功率较高。结论这项研究的结果表明，在超声引导下锁骨下静脉置管的锁骨上入路具有统计学上的优势。平均程序时间越短，以及静脉可视化的持续时间，穿刺,和导管插入术，强调锁骨上技术的效率。始终如一地取得100%的成功率，再加上较高的首次尝试成功率，进一步强调锁骨上锁骨下静脉组的熟练程度。这些结果共同表明，锁骨上入路不仅具有时间效率，而且在成功放置中心线方面也具有优势。使其成为急诊和重症监护环境的一个有希望的选择。
