• Qingyu Wang, Jiming Cai, Zhiwei Lu, Qun Zhao, Yufang Yang, Li Sun, Qun He, and Shaoyi Xu.
• Department of Intensive Care Unit, Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
• J Emerg Med. 2020 Dec 1; 59 (6): 918-926.

BackgroundSubclavian vein puncture is commonly used in the intensive care unit (ICU) but is associated with complications.ObjectiveOur aim was to compare the efficacy and safety of static ultrasound-guided subclavian vein puncture with traditional anatomical landmark-guided subclavian vein puncture in critically ill patients in the ICU.MethodsThis pilot randomized controlled trial enrolled patients admitted to the ICU and requiring subclavian vein puncture between November 2017 and September 2018. The patients were randomized to ultrasound-guided puncture or anatomical landmark-guided puncture. The primary outcome measure was the puncture success rate. The secondary outcome measures included the number of punctures, rate of success at the first attempt, puncture time (i.e., procedure duration) and incidence of complications.ResultsA total of 194 patients were included in the analyses. Compared with the anatomical landmarks group, the ultrasound group had a higher puncture success rate (91.7% vs. 77.6%; p = 0.007), lower rate of complications (7.3% vs. 20.4%; p = 0.008), and lower incidence of mispuncture of an artery (2.1% vs. 14.3%; p = 0.002). There were no significant differences in the number of punctures and puncture time between the two groups (both, p > 0.05).ConclusionsStatic ultrasound-guided subclavian vein puncture is superior to the traditional landmark-guided approach for critically ill patients in the ICU. It is suggested that static ultrasound-guided puncture techniques should be considered for subclavian vein puncture in the ICU.Trial RegistrationChiCTR1900024051.Copyright © 2020 Elsevier Inc. All rights reserved.

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