Ultrasound Better Than Landmark Guidance for Subclavian Vein Cannulation

Ultrasound-guided procedures are becoming increasingly common in the emergency department, but do they improve outcomes? Investigators in Greece prospectively randomized 463 sedated and ventilated intensive care unit patients to undergo infraclavicular subclavian vein cannulation guided by real-time ultrasound or the landmark method; 62 patients in the landmark group were converted to the ultrasound group because of technical difficulties and were excluded.

Ultrasound guidance was associated with a significantly higher success rate (100% vs. 88%), shorter access time (mean, 27 vs. 45 seconds), and fewer attempts (mean, 1.1 vs. 1.9). Complications were significantly more frequent in the landmark group (10 pneumothoraces, 9 hemothoraces, 6 bra…