Comparative evaluation of the clinical safety and efficiency of supraclavicular and infraclavicular approaches for subclavian venous catheterization in adults: A meta-analysis

Abstract

Background: In this meta-analysis, we investigated the success rate of subclavian venous catheterization (SVC) as well as the incidence of related complications when performed via the supraclavicular (SC) or traditional infraclavicular (IC) approaches.

Methods: Ignoring the original language, we identified and analyzed eight randomized controlled trials (RCTs) published on or before December 30, 2018, after searching the following five bibliographic databases: PubMed, Springer, Medline, EMBASE, and the Cochrane Library. All included studies compared the clinical safety and efficiency of the SC and IC approaches for SVC in adults. The Cochrane Collaboration's Risk of Bias Tool was used to evaluate the methodological quality of each RCT. Cannulation failure rates and the incidence of malposition were regarded as the primary outcome measures. Secondary outcome measures included cannulation access time and the incidence of pneumothorax and artery puncture.

Results: Failure rates were significantly lower for SVC via the SC approach than via the IC approach [odds ratio, 0.66; 95% confidence interval (CI), 0.47 to 0.93]. The SC approach was also associated with a decreased incidence of catheter malposition, relative to that observed for the IC approach [odds ratio, 0.24; 95% CI, 0.13 to 0.46]. The SC approach did not reduce the time required for cannulation [mean difference, -74.74; 95% CI, -157.80 to 8.33], and there were no differences in the incidence of artery puncture [odds ratio, 0.60; 95% CI, 0.29 to 1.23] or pneumothorax [odds ratio, 0.89; 95% CI, 0.33 to 2.40].

Conclusion: Our findings suggest that SVC via the SC approach should be utilized in adults.

Keywords: Catheterization; Infraclavicular approach; Meta-analysis; Supraclavicular approach.