Sterner S, Plummer D W, Clinton J, Ruiz E
Ann Emerg Med. 1986 Apr;15(4):421-4. doi: 10.1016/s0196-0644(86)80179-2.
Five hundred emergency department patients requiring subclavian vein catheterization were randomized prospectively into one of two groups, supraclavicular or infraclavicular. If catheterization was unsuccessful in a few attempts using the randomized approach, catheterization with the alternate approach was attempted. Two catheters were available for use, a short, 8-French introducer and a long, 16-gauge catheter. There were 38 failures (15.5%) among 245 patients in the supraclavicular group, with one malposition and five complications. There were 51 failures (20.0%) among 255 patients in the infraclavicular group, with 21 malpositions and 13 complications. No differences were significant except that of malpositions (P less than .01). The combination of infraclavicular approach and 16-gauge catheter accounted for 21 of 22 malpositions. When catheterization by the randomized approach failed, catheterization by the alternate approach was successful in all but seven cases, resulting in an overall success rate of 98.6%. Analysis of this series suggests that both the infraclavicular and supraclavicular approaches to subclavian vein catheterization are acceptable alternatives, with little difference in success rate or complications. Using an alternate approach if the initial approach was unsuccessful produced a high overall success rate and a low overall complication rate. A physician who is familiar with both approaches will be more successful at placing central venous catheters safely.
五百名需要进行锁骨下静脉置管的急诊科患者被前瞻性地随机分为两组，即锁骨上组或锁骨下组。如果使用随机方法进行几次置管尝试均未成功，则尝试使用另一种方法进行置管。有两种导管可供使用，一种短的8F引导器和一种长的16号导管。锁骨上组245例患者中有38例失败（15.5%），其中1例位置不当，5例出现并发症。锁骨下组255例患者中有51例失败（20.0%），其中21例位置不当，13例出现并发症。除位置不当外，其他差异均无统计学意义（P<0.01）。锁骨下途径和16号导管的组合导致了22例位置不当中的21例。当随机方法置管失败时，除7例病例外，采用另一种方法置管均成功，总体成功率为98.6%。对该系列的分析表明，锁骨下静脉置管的锁骨下途径和锁骨上途径都是可接受的替代方法，成功率或并发症方面差异不大。如果初始方法不成功则采用另一种方法可获得较高的总体成功率和较低的总体并发症发生率。熟悉这两种方法的医生在安全放置中心静脉导管方面会更成功。
