• H-J Byon, G-W Lee, J-H Lee, Y-H Park, H-S Kim, C-S Kim, and J-T Kim.
• Department of Anesthesiology and Pain Medicine, Inha University Hospital, Incheon, Republic of Korea.
• Br J Anaesth. 2013 Nov 1;111(5):788-92.

BackgroundUltrasound (US)-guided subclavian vein (SCV) catheterization via the supraclavicular (SC) or infraclavicular (IC) approaches can be useful in children. The purpose of this study was to compare the efficacy of these approaches.MethodsThis prospective, randomized study included 98 children who were <3 years old, and who were divided into two groups: the SC group (n=49) and the IC group (n=49). All SCV catheterizations were guided by US and performed by a single experienced anaesthesiologist. Data regarding puncture time, number of attempts, successful guidewire insertion, catheter insertion time, and complications were analysed.ResultsThe median puncture time was longer in the IC group than the SC group (48 vs 36 s, P=0.02). Multiple attempts (number of attempts >3) were more frequently required in the IC group than the SC group (24.5 vs 6.1%, P=0.01). The incidence of guidewire misplacement was higher in the IC group than that of the SC group [10 (20.4%) vs 0 (0%), P=0.001]. Catheterization was successfully performed in all patients. No pneumothoraces or arterial punctures occurred in either group.ConclusionDuring SCV catheterization under US guidance in paediatric patients, the SC approach yielded a shorter puncture time and decreased the incidence of guidewire misplacement when compared with the IC approach.

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