Several advantages of the subclavian vein for central access include its large diameter, absence of valves, and ability to remain patent. Subclavian catheterization also carries a lower risk of catheter-related infection and thrombosis than femoral or internal jugular vein catheterization 1,7,8. Furthermore, this approach offers a reduced rate of infection, thrombosis, improved patient comfort and tolerance and the cannulation is often easier in hypovolaemic patients 9–11. Moreover, to guarantee access to the neck and ensure venous blood drainage from the brain the SCV approach provides an important advantage in the setting of neurosurgical intensive care units.
Since CV catherization remains an important procedure for patients being treated within intensive care units, the safety of the procedure, reduction of the complications rate is still an important issue. Many studies have been published comparing US-guided techniques and landmark-based techniques puncturing either IJV or SCV and supporting the superiority of US-guided techniques in reduction of complications and attempts until successful catheterization. Nevertheless, to date, no data exists reporting safety and complication rates puncturing IJV with US-support and SCV using landmark technique. With regard to complication rate, no significant differences were demonstrated between the SCV and IJV groups. The only significant parameter was the number of attempts more than 3, which was higher in the SCV group. These findings are in line with previous published data, which underline the almost similar complications rates of mechanical complications, but the superiority of the US -guided technique in terms of average access time and number of attempts between internal jugular and subclavian venous catheterization 12–14.
The use of CVCs may be associated with adverse effects to patients 1. Mechanical complications are reported to occur up to 20% of patients, infectious and thrombotic complications up to 30% 15,16. Thus, the procedure of CVC remains a high complicative approach, which should be indicated with great attention and be performed under safe conditions.
So, the research in terms of safety approach and the use of technical support are still important and of need. So, we tried to provide further insight in this field by presenting our achieved data. One aspect should be noticed, that the cannulation of the SCV using US require greater technical US skill due to its route beneath the clavicle6,17,18. Nevertheless, we could show, that the SCV access remains an alternative approach in neurosurgically treated patients.