l Comparison Of Ultrasound -Guided Internal Jugular Vein And Supraclavicular Subclavian Vein -A Randomized Control Trial

Central venous cannulation (CVC) is a vital intervention in the operation theatre, intensive

care unit, and emergency room. Common clinical applications of CVC include central

venous pressure (CVP) monitoring in major surgeries, administration of drugs,

hyperosmolar solutions and blood products.

Internal jugular vein (IJV) cannulation being the most adopted route for central venous

access, it is associated with several problems like proximity to neck vessels leading to

arterial puncture, and difficulty in access in obese, edematous, and hypovolemic patients.

The subclavian vein is advantageous anatomically owing to its huge caliber, absence of

valves, and support of surrounding structures which keeps the vein patent even in shock.

Traditionally, the internal jugular vein (IJV) and subclavian vein have been the preferred sites

for central venous access.

With advances in technology, the use of ultrasound has become the standard of care in

medical practice overcoming the limitations of landmark-based techniques. Ultrasound allows

realtime visualization of the vein ensuring successful cannulation with fewer attempts and

less complication rate.However, the choice between these two approaches remains a

subject of clinical debate, especially with the advent of ultrasound guidance, which has

significantly improved the accuracy and safety of these procedures.

As anesthesiologist Tomasz Czarnik and co-authors (2009) say: “In conclusion, subclavian

venous cannulation via the supraclavicular approach is an excellent method of central venous

access in anesthesia. The procedure success rate and the significant complication rate are

comparable to other techniques of central venous cannulation especially to jugular access,

which is regarded by most physicians as the safest one. Mechanical ventilation is not a risk

factor associated with significant complications. The supraclavicular approach should be

considered, especially in neuroanesthesia, where the right jugular approach could be

associated with cerebral perfusion pressure reduction, intracranial pressure elevation, and

venous stasis. The supraclavicular approach seems to be more comfortable than the jugular

approach in a conscious patient. This method can be successfully and relatively safely used

as a primary or alternative technique when other catheterization sites are not available to

augment the spectrum of catheterization possibilities, even in mechanically ventilated

patients”.

This thesis aims to compare the efficacy, safety, and clinical outcomes of ultrasound-guided

internal jugular vein and supraclavicular subclavian vein cannulation.