Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterisation: An updated systematic review and meta-analysis of randomised controlled trials

Background and Aims: Subclavian vein catheterisation (SVC) is more effective than internal jugular or femoral catheterisation and is linked to a lesser incidence of infection and patient discomfort. Whether the supraclavicular (SC) or infraclavicular (IC) approach is more effective for SVC is unclea...

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Bibliographic Details
Published in:Indian journal of anaesthesia 2023-06, Vol.67 (6), p.486-496
Main Authors: Imai, Eriya, Watanabe, Jun, Okano, Hiromu, Yokozuka, Motoi
Format: Article
Language:English
Subjects:
Analysis
catheterisation
Catheterization
Comparative analysis
Health aspects
infraclavicular approach
Meta-analysis
Methods
Patient outcomes
subclavian vein
supraclavicular approach
Systematic review
Systematic Review and Meta-Analysis
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Summary:Background and Aims: Subclavian vein catheterisation (SVC) is more effective than internal jugular or femoral catheterisation and is linked to a lesser incidence of infection and patient discomfort. Whether the supraclavicular (SC) or infraclavicular (IC) approach is more effective for SVC is unclear in the previous systematic review. This updated review is designed to search the efficacy and safety of both approaches adopting the Grading of Recommendations Assessment, Development and Evaluation approach. Methods: In May 2022, we explored the databases of Embase, MEDLINE, CENTRAL, ClinicalTrials.gov and WHO-ICTRP for randomised controlled trials to compare the two approaches. Results: Seventeen trials (2482 cases) were included. In the primary outcomes, the SC approach likely reduces the failure proportion (relative risk [RR], 0.63; 95% confidence interval [CI], 0.47-0.86; I2 = 5%) and the incidence of malposition (RR, 0.23; 95% CI, 0.13-0.39; I2 = 0%) with moderate evidence and may slightly reduce the incidence of arterial puncture and pneumothorax (RR, 0.59; 95% CI, 0.29-1.22; I2 = 0%) with low evidence. In the secondary outcomes, the SC approach may decrease the access time and may increase the first-attempt success proportion. Conclusion: The SC approach for SVC should be selected after considering the clinician's expertise.
ISSN:0019-5049
0976-2817
DOI:10.4103/ija.ija_837_22