Subclavian vein catheterization during cardiopulmonary resuscitation. A prospective comparison of the supraclavicular and infraclavicular percutaneous approaches.

Percutaneous access to the central venous circulation is indicated in the management of some cardiopulmonary arrests. We prospectively studied 89 attempted subclavian vein catheterizations in a total of 76 patients. There were 44 supraclavicular (SC) and 45 infraclavicular (IC) approaches. We found that the percutaneous SC route provides a better technique than the IC approach: it is associated with fewer failures, less difficulty in the mechanics of line insertion, a higher incidence of proper catheter tip location, and much less interference with cardiopulmonary resuscitation in normal, obese, and cachectic patient subgroups. Successful performance occurred despite a documented lack of physician experience with the SC technique, indicating that it should be taught during advanced cardiac life support training courses.