Supraclavicular approach to subclavian catheterization: review of the literature and results of 178 attempts by the same operator.

Over a period of 15 months, 178 consecutive attempts at supraclavicular catheterization of the subclavian veins were performed by the same operator. There were 42 additional central lines inserted during this period, which were placed via other methods as specified by the attending physicians. Results of the supraclavicular approach are presented and are believed to be the largest reported series of supraclavicular line insertions by one operator. Forty-five of the supraclavicular lines were placed after failed attempts by other emergency room and surgical physicians. Five were inserted in patients that were in hypovolemic shock, and three were placed in morbidly obese patients weighing 800, 400, and 335 pounds. Of the 178 attempts, there was only one significant complication: a left-sided pneumothorax on the 21st attempt in an emphysematous patient. The vein was successfully accessed in 177 cases with only two instances of inability to thread the catheter and one instance of malposition. Overall, there was satisfactory placement in 97.8% of attempts with a significant complication rate of 0.56%. This paper intends to describe the details of subclavian venipuncture by the supraclavicular technique, and, because of the high degree of reliability and safety of this technique in experienced hands, to recommend it as an excellent alternative for central venous access --especially in difficult cases.