• Steven J Socransky, Ray Wiss, Maja R Stachura, and Martin Betz.
• Department of Emergency Medicine, St Paul's Hospital, Vancouver, BC, Canada.
• Am J Emerg Med. 2014 Aug 1;32(8):905-8.

IntroductionUltrasound guidance for central line placement in the subclavian vein (SCV) is more efficient and safer than landmark-based technique. The supraclavicular (SC) approach is an alternative to the infraclavicular (IC) approach, but the research is sparse. The objective was to determine which approach provides the best view.MethodsThis was a prospective anatomical survey of voluntary normovolemic patients. Four experienced emergency physicians and 1 resident scanned the right and left SCVs from SC and IC approaches. They assigned a score for the views obtained on a 5-point Likert scale.ResultsNinety-eight patients were enrolled. Mean Likert scores for the 4 views were: right SC, 4.06 (95% confidence interval [CI], 0.22); right IC, 3.07 (95% CI, 0.25); left SC, 3.82 (95% CI, 0.23); left IC, 3.12 (95% CI, 0.25). When combining data from right and left, the mean score for the SC view was significantly higher than the mean score for the IC view: 3.94 (95% CI, 0.16) vs 3.10 (95% CI, 0.18). The following ratings were obtained: right SC view was good or excellent in 71.5%; left SC view was good or excellent in 66.3%; right IC view was good or excellent in 37.8%; and left IC view was good or excellent in 38.8%.ConclusionThe SC approach allows for a better view of the SCV on ultrasound than the IC approach. Future research should determine if this translates to a greater success rate when placing central lines in the SCV.Copyright © 2014 Elsevier Inc. All rights reserved.

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