title: A randomized clinical trial of ultrasound-guided infra-clavicular cannulation of the subclavian vein in cardiac surgical patients: short-axis versus long-axis approach.
abstract: OBJECTIVE
  The aim of this study was to compare the success rate and safety of short-axis versus long-axis approaches to ultrasound-guided subclavian vein cannulation.
  
  
  METHODS
  A total of 190 patients requiring central venous cannulation following cardiac surgery were randomized to either short-axis or long-axis ultrasound-guided cannulation of the subclavian vein. Each cannulation was performed by anesthesiologists with at least 3 years' experience of ultrasound-guided central vein cannulation (>150 procedures/year, 50% short-axis and 50% long-axis). Success rate, insertion time, number of needle redirections, number of separate skin or vessel punctures, rate of mechanical complications, catheter misplacements, and incidence of central line-associated bloodstream infection were documented for each procedure.
  
  
  RESULTS
  The subclavian vein was successfully cannulated in all 190 patients. The mean insertion time was significantly shorter (p = 0.040) in the short-axis group (69 ± 74 s) than in the long-axis group (98 ± 103 s). The short-axis group was also associated with a higher overall success rate (96 vs. 78%, p < 0.001), first-puncture success rate (86 vs. 67%, p = 0.003), and first-puncture single-pass success rate (72 vs. 48%, p = 0.002), and with fewer needle redirections (0.39 ± 0.88 vs. 0.88 ± 1.15, p = 0.001), skin punctures (1.12 ± 0.38 vs. 1.28 ± 0.54, p = 0.019), and complications (3 vs. 13%, p = 0.028).
  
  
  CONCLUSIONS
  The short-axis procedure for ultrasound-guided subclavian cannulation offers advantages over the long-axis approach in cardiac surgery patients.
authors.affiliation: Department of Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Vezzani
authors.affiliation: Department of Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Manca
authors.affiliation: Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Mura Della Cappuccine 14, 16128, Genoa, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Brusasco
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Santori
authors.affiliation: Department of Emergency Medicine, Fidenza Hospital, AUSL of Parma, Parma, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cantadori
authors.affiliation: Department of Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ramelli
authors.affiliation: Department of Cardiology, University Hospital of Parma, Parma, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Gonzi
authors.affiliation: Department of Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.affiliation: Department of Surgery, University Hospital of Parma, Parma, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
authors.affiliation: Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Mura Della Cappuccine 14, 16128, Genoa, Italy. francescorradi@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Corradi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Central venous cannulation; Scanning axis; Subclavian vein; Ultrasound