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Richard J. Bold, MD; David J. Winchester, MD; Alice R. Madary, RN, BSN; Mary Ann Gregurich, MPH, PhD; Paul F. Mansfield, MD

Arch Surg. 1998;133:1089-1093.

Objective  To examine the rate of success and complications of Doppler-guided subclavian vein catheter insertion compared with standard insertion in patients considered at high risk for failure.

Design  Prospective, randomized, crossover trial.

Setting  University-affiliated tertiary care medical center.

Patients  Two hundred forty patients were enrolled in the study. Patients were stratified for 3 known risk factors: (1) prior surgery in the subclavian vein region, (2) prior radiotherapy at the attempted catheterization site, and (3) an abnormal weight-height ratio.

Interventions  Subclavian vein catheterization was performed either in standard or Doppler-guided fashion using the Smart Needle (Peripheral Systems Group, Mountain View, Calif), which is a Doppler probe at the tip of a cannulating needle. If subclavian vein catheterization was unsuccessful after 2 attempts, patients were crossed over to the other technique.

Main Outcome Measure  Successful cannulation of the subclavian vein.

Results  The success rate, either as an initial technique or as a salvage technique, and complication rate were not significantly different with use of the Smart Needle. A subgroup of physicians had a significantly lower success rate using the Smart Needle.

Conclusions  Doppler guidance did not increase the success rate or decrease the complication rate of subclavian vein catheterization when compared with the standard technique in high-risk patients. Doppler guidance was not more useful than the standard technique as a salvage technique following a previous failure of catheterization. Furthermore, real-time Doppler guidance of subclavian vein catheterization is a technique that is highly operator dependent.

From the Departments of Surgical Oncology (Drs Bold, Winchester, and Mansfield and Ms Madary) and Biomathematics (Dr Gregurich), University of Texas M. D. Anderson Cancer Center, Houston. Dr Winchester is currently with Northwestern University, Evanston Hospital, Evanston, Ill.

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