LE T T E R Open Access
Longing for better ultrasound-guided
subclavian/axillary venous cannulation
Gentle Sunder Shrestha
Ultrasound guidance for central venous catheter (CVC)
placement reduces complications, increases safety and en-
hances the quality of the procedure . Existing guidelines
suggest a higher level of evidence for ultrasound-guided
internal jugular venous cannulation compared with the
subclavian/axillary route . Meta-analysis of trials study-
ing the use of ultrasound guidance for subclavian venous
cannulation, when compared with the landmark tech-
nique, showed decreased incidence of arterial puncture
and hematoma formation, but there was no overall differ-
ence in complications and success rates .
Smaller studies have shown that patient positioning dur-
ing cannulation of the subclavian vein (e.g., turning the
head to the contralateral side, shoulder-pulled-downward
position, and abducted position of arm) can alter the rela-
tionship between the subclavian vein and the internal
jugular vein and can also alter the cross-sectional area of
the vein, thus potentially affecting the safety and success of
cannulation [4, 5]. Further well designed studies should try
to explore the influence of these various patient positions
on ultrasound-guided subclavian venous cannulation.
CVC: Central venous catheter
GSS contributed to the concept, design, literature search, manuscript writing,
editing, and review. The author read and approved the final manuscript.
The author declares that he has no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Received: 29 April 2018 Accepted: 21 May 2018
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Department of Anaesthesiology, Critical Care Unit, Tribhuvan University
Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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Shrestha Critical Care (2018) 22:148