# Comparative Evaluation of Supraclavicular Versus Infraclavicular Approach With Regard to Right Subclavian Vein Catheterisation by Blind Approach

## TL;DR

This study compares two methods for placing a vein catheter in the neck area and finds one method is faster without compromising safety.

## Contribution

The study provides evidence that the supraclavicular approach is faster for blind central venous access in cardiac surgery patients.

## Key findings

- The supraclavicular approach reduced total cannulation time by nearly a minute compared to the infraclavicular approach.
- The success rate was high for both methods, with no major complications observed.
- The supraclavicular approach had fewer arterial punctures compared to the infraclavicular approach, though not statistically significant.

## Abstract

Background

In settings where real-time ultrasonography (USG) is unavailable or delayed, landmark-guided central venous access remains essential. Anatomically, the right supraclavicular (SC) route offers a more direct course to the superior vena cava than the infraclavicular (IC) approach, which could shorten procedural time without increasing risk.

Methods

We conducted a prospective, single-centre, parallel-group randomised controlled trial in adult elective cardiac surgery patients (n=70; 35 per arm) comparing landmark-guided right subclavian venous catheterisation via SC versus IC approaches, using a standardised Seldinger technique. The primary outcome was total cannulation time. Secondary outcomes included access time, number of puncture attempts, observer-rated ease of guidewire/catheter passage, success rate and complications. Binary outcomes were analysed for all randomised patients; timing outcomes were assessed in procedures with complete records (n=62; SC: 32, IC: 30).

Results

SC significantly reduced procedure duration. The mean total cannulation time was 2.98±0.59 minutes (SC) versus 3.70±0.77 minutes (IC), with a mean difference of -0.72 minutes (95% confidence interval (CI): -1.07 to -0.37; p<0.001). The mean access time was 17.72±17.89 seconds (SC) versus 35.80±33.63 seconds (IC), with a mean difference of -18.1 seconds (95% CI: -32.0 to -4.2; p=0.012). The distribution of puncture attempts and observer-rated ease scores did not differ materially between groups. Overall success was high (94.3% SC versus 85.7% IC; Fisher’s exact test; p=0.428). Complications were infrequent: subclavian arterial puncture occurred in 2/35 (SC) versus 5/35 (IC) (p=0.428); no pneumothorax, haemothorax, haematoma or catheter malposition was observed.

Conclusions

In adult cardiac surgical patients, the SC approach achieves faster landmark-guided right subclavian venous access than the approach, without detectable compromises in success or safety. These findings support routine competence with the SC technique when ultrasound cannot be used and justify larger multicentre trials powered for rare complications and operator-learning effects.