An alternative central venous route for cardiac surgery: supraclavicular subclavian vein catheterization.

Objective: To evaluate the clinical success rate, safety, and usefulness for intraoperative central venous pressure monitoring, and the intravenous access of the supraclavicular subclavian vein approach when compared with the infraclavicular subclavian vein approach and the internal jugular vein approach for central venous catheterization during open-chest cardiac surgery.

Design: A prospective, randomized, single-center study.

Setting: A university hospital.

Participants: One hundred ninety-five patients scheduled for open-chest cardiac surgery.

Interventions: The study population consisted of patients for whom central vein catheterization was intended during cardiac surgery. Patients were randomized to 3 groups according to the route of central vein catheterization: the supraclavicular group: the supraclavicular approach for the subclavian vein (n = 65); the infraclavicular group: the infraclavicular approach for the subclavian vein (n = 65); and the jugular group: the internal jugular vein approach (n = 65). After the induction of anesthesia, central venous catheterization was performed according to the assigned approach.

Measurements And Main Results: The success rates for the assigned approach were 98%, 98%, and 92% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). The success rates in the first 3 attempts in patients who were catheterized successfully according to the assigned approach were 96%, 100%, and 96% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). There was no difference among groups in catheter insertion time (p > 0.05). After sternal retraction, central venous pressure trace loss and difficulty in fluid infusion were significantly more frequent in the infraclavicular group (21%) when compared with the supraclavicular (3%) and jugular groups (0%) (p = 0.01). There was no difference among groups in terms of catheter malposition, complications during catheterization, and rate of catheter-related infection.

Conclusion: The supraclavicular approach for subclavian vein catheterization is an acceptable alternative for central venous access during cardiac surgery in terms of procedural success rate, ease of placement, rate of complications, and usability after sternal retractor expansion.