Supraclavicular approach to the subclavian vein – one well forgotten technique with impressive results

Abstract

Purpose: Insertion of temporary and tunneled catheters for hemodialysis in the internal jugular vein is a gold standard. On the other hand, the supraclavicular approach to the subclavian vein is described by Yoffa in 1965. Despite its old invention, the latter technique is well forgotten for unknown reasons. The aim of this study is to present our experience with the usage of the supraclavicular approach for insertion of temporary and tunneled catheters. Material and Methods: We provide our experience on insertion of 506 temporary and 501 tunneled catheters within a five-year period (from 1st January 2010 to 31st December 2014). We use 8 (eight) different places for catheters insertion, including the subclavian vein by the supraclavicular approach following the techniques of D. Yoffa and J. Gorchynski. The collected data include age, sex, reasons for hemodialysis, number of attempts for successful cannulation, number of acute (AC) and chronic (CC) complications, and dependence on the catheter insertion location. Results: The gender distribution shows 463 (46 %) women and 544 (54 %) men with median age of 60.0 (+/- 13.2) years. In the cases of temporary catheters: 104 (20.5%) are inserted in the subclavian vein by the supraclavicular approach (SCVSC), 70 (13.8%) – in the internal jugular vein (IJV); in the cases of tunneled ones – SCVSC – 281 (56%), and IJV – 207 (41%) catheters, respectively. We found significant statistical correlation (p < 0.05 and r = 0.23) between the acute complications and the insertion position – AC are more for IJV insertion, than in SCVSC. We did not find significant correlation between the insertion place and the chronic complications. Even central vein stenosis is more frequent in the IJV than in the SCVSC, but this is not significant (p > 0.05). Primary catheter patency of temporary and tunneled catheters is higher when they are inserted in the left veins. Conclusion: We conclude that the supraclavicular approach to the subclavian vein is easier, safer and a practically more convenient method than the cannulation of the IJV. The revisit of this approach demonstrates that it should be more widely used.