Infraclavicular subclavian vein catheterisation: a randomised controlled trial comparing standard ultrasound guidance and a new needle guidance device.
Nicolas Boulet, Laurent Muller, Hugo Guillermou et al.
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In 30 seconds
This single-centre randomised controlled trial compared magnetic needle-tracking with standard ultrasound guidance for infraclavicular subclavian catheterisation in ICU patients. Among 124 randomised patients, uncomplicated first-puncture success was 82.5% (47/57) with magnetic tracking and 69.8% (44/63) with standard guidance, an absolute difference of +12.6% (p = 0.053), which was not statistically significant. The composite of immediate mechanical complications and procedure failures was lower with magnetic tracking (8.8% versus 22.2%; absolute difference, -13.5%; p = 0.044).
Key findings
- Uncomplicated first-puncture success was 82.5% with magnetic tracking versus 69.8% with standard ultrasound (absolute difference, +12.6%; p = 0.053).
- The composite of immediate mechanical complications and procedure failures occurred in 8.8% versus 22.2% (absolute difference, -13.5%; p = 0.044).
- Among spontaneously breathing patients, first-puncture success was 85.7% versus 52.9% (absolute difference, +32.8%; p = 0.058), and catheterisation duration was shorter with magnetic tracking (p = 0.027).
- The subgroup differences were not observed in mechanically ventilated patients.
Why it matters
Subclavian catheterisation may be underused because of perceived technical difficulty. This trial suggests magnetic needle-tracking could reduce immediate complications and procedure failures, although it did not establish a significant improvement in the primary outcome overall. The subgroup findings also suggest that patient ventilation status may be relevant when evaluating the device, but require confirmation.
What to keep in mind
The trial was single-centre, and the overall primary outcome difference was not statistically significant. The subgroup findings warrant confirmation.