Comparison of ultrasound guided supraclavicular subclavian vein versus infraclavicular subclavian/axillary vein catheterization: A systematic review and meta analysis

Abstract

Background: Subclavian vein cannulation is an important technique of central venous cannulation with a supraclavicular and an infraclavicular approach. There are randomized controlled trials (RCTs) which highlight the various differences between these two approaches when accessed via ultrasound. We undertook a meta-analysis to compare the ultrasound guided supraclavicular subclavian and the infraclavicular subclavian/axillary vein cannulation, keeping in mind that the infraclavicular approach may lead to cannulation of either subclavian/axillary vein. Methods: This meta-analysis encompassed studies that compared ultrasound-guided supraclavicular subclavian vein and infraclavicular subclavian/axillary vein. Binary outcomes were presented as odds ratios (OR), while continuous outcomes were presented as standardized mean differences (SMD) accompanied by 95% confidence intervals (95% CI). Potential trials meeting the eligibility criteria were sought from databases including PubMed, PubMed Central, The Cochrane Library, and EMBASE, covering the period from inception to April 30, 2023. Results: The analysis comprised a total of six randomized controlled trials (RCTs) and one retrospective observational study collectively involving 1812 patients. The first pass success rate for subclavian vein catheterization was found to be greater with the supraclavicular approach (OR = 1.91 [95% CI 1.04–3.50]; p = 0.0002; I2 = 77%). Moreover, the supraclavicular approach exhibited a significantly shorter catheterization time compared to the infraclavicular approach (SMD = −0.26 [95% CI −0.54 to 0.03]; p = 0.003; I2 = 73%). Notably, there was no substantial disparity in complication rates between the two approaches (OR = 0.66 [95% CI 0.35–1.24]; p = 0.20; I2 = 0%). Conclusion: Ultrasound-guided supraclavicular approach for subclavian vein catheterization is superior to the infraclavicular approach for subclavian/axillary vein catheterization, with higher first-pass success rates, shorter catheterization times. However, there were no differences in the complication rates.