The comparison of central internal jugular and supraclavicular subclavian venous catheterization in emergency department

Abstract

Objectives: To compare the complications, process duration and the challanges of central internal jugular (IJ) and supraclavicular (SC) subclavian venous accesses in the emergency department.
Materials and Methods: All emergency residents underwent a theoretical and practical training, before this prospective, randomized, controlled trial. Randomization were performed via sealed opaque envelopes. The number of punctures, the difficulty of the procedure via Likert scale and the necessity of an attending physician for the procedure were recorded to the study form. Vital signs of the study patients, Glasgow Coma Scale Score and findings on the chest X-ray were also recorded at the end of the procedure. Patients were followed-up at the first and 15th days of the procedure for possible pathologies in ECG and chest X-ray, development of a local hematoma and/or infection, systemic infection and for other possible findings related to the catheterization.
Results: A total of 85 patients were included into the present study in an 18 month period. The most commonly noted indications for central venous catheterization were central venous pressure monitoring (n=81; 95.3%), total parenteral nutrition (n=38; 44.7%) and both (n=37; 43.5%). The rate of ‘failed first attempt’ (IJ; n=4; 9.1%vs SC; n=6; 14.6%) were similar between two groups (p=0.431). The complication rates between two groups were similar just after the procedure, on the first day and 15th days after the procedure despite the lack of a statistical procedure. The level of difficulty of the procedures was similar in both groups (p=0.128).
Conclusion: After a brief constructed training period, either IJ or SC central venous access should be prefered as an inherent part of the management of the critically ill patients in emergency department, unless a specific contraindication exists.