• Marco Milone, Giovanni Di Minno, Matteo Nicola Dario Di Minno, Giuseppe Salvatore, Carmine Iacovazzo, Carmela Policastro, and Francesco Milone.
• Department of Surgery, Orthopedy, Traumatology and Emergency, University of Naples "Federico II" Naples, Italy. milone.marco@alice.it
• Ann Ital Chir. 2010 Sep 1; 81 (5): 331-4.

AimThe technique of ultrasound-guided subclavian cannulation was evaluated in our experience assessing the real effectiveness of such procedure.MethodsWe have evaluated 297 subclavian cannulation, performed for the placement of central venous catheter both with landmark method (176 patients) and ultrasound guided technique (121 patients) to assess the real effectiveness of the ultrasound-guided technique to reduce the mechanical complication of the subclavian vein puncture.ResultsA total of 23 mechanical complications were identified. Of these, 8 were pneumothorax and 15 arterial puncture. Such cases were identified from the pool of patients who had undergone subclavian venous cannulation with landmark method. However these complications occurred only in difficult venous access and teaching procedure performed with landmark method.DiscussionAn ultrasound-guided recent technique for the placement of central venous access should be adopted since such technique seems to reduce the incidence of failure and mechanical complications. However it is worth notice that the clinical effect of using ultrasound guidance technique seems to be more significant when the internal jugular vein rather than the subclavian vein is cannulated.ConclusionOur experience demonstrate that, both in no difficult cases and in no teaching procedures, central venous catheterization using landmark technique seems to be acceptable on both clinical and medico-legal grounds. However the ultrasound guided technique is necessarily required to achieve the reduction of complications in difficult venous access.

7 keywords...

hide…