Evaluation of a modified technique to secure central venous assess by infraclavicular subclavian approach

Background and Aim: To assess the safety and efficacy of infra-clavicular subclavian approach for central venous cannulation in initial three attempts. Settings and Design: Study was conducted between 2011-2017 parturients, at JNMC, wardha, India. Materials and Methods: The study was conducted in surgical intensive care unit, Dept of Anaesthesiology, JNMC, Sawangi after seeking approval from ethics committee. The study group consisted of patients admitted in surgical ICU. Patients were given sedation if necessary, proper positioning done. Under all aseptic precaution the site of puncture was identified. An imaginary line perpendicular to the junction of medial two third and lateral one third was marked. Another horizontal line from sternal notch perpendicular to the vertical line was drawn, the site marked and infiltrated with 10ml of Inj.1% lignocaine. The y-finder needle inserted at the above mentioned point to hit the clavicle first and then passed below it to puncutre the vein. Chest x-ray done to confirm placement. If unsuccessful the procedure was done by another investigator.If still unsuccessful the procedure was abandoned and labeled as failure. Any complication like arterial puncture,number of attempts and number of failures were noted. Results: Demographic data Of total 1901 patients in 93.95% cases, subclavian vein cannulation was successful in 1st attempt, 4% cases in 2nd attempt and 1.94% cases in 3rd attempt. In 7 patients of total 1908 patients, procedure was abandoned due to irritability and with >3 attempts.Complications including failure to cannulate occurred in 116 patients (6.07%).