130 - Comparative Analysis of Blind Techniques for Central Line Placement in Hypovolemic Patients: Supraclavicular vs. Infraclavicular Approach in Cadaveric Model

Poster Board Number: 130
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Odd poster #s – first hour
Even poster #s – second hour

Co-authors:

Dominic Maiuro, MSc - Kansas City University; Chloe Maye - Kansas City University; Omer Riyadh, MSc - Kansas City University; Swathi Sridhar, MSc, MPH - Kansas City University; Kenneth Stewart, DO - Kansas City University; Melissa Zolnierz, PhD - Kansas City University

Abstract Body :
Introduction & Objective: Central venous line placement is an invasive procedure that allows recipients to receive medications rapidly through a catheter placed into a large vein. Patients with hypovolemia (decreased blood fluid) require prompt fluid resuscitation through these lines. The subclavian vein is a common location due to multiple accessibility points. The infraclavicular (IC) approach is utilized more often, while the supraclavicular (SC) approach is seldom used due to physicians' unfamiliarity with it. Despite similar success rates in line placement, there could be an advantage in using one or the other method in hypovolemic patients, where gaining access to a large vein can prove difficult even with imaging assistance. This study aims to see if there is a difference between the two approaches in gaining venous access by utilizing cadavers that simulate hypovolemia. We also compare anatomical differences between left and right subclavian access to see if this impacts success as well. Methods: A clinician experienced in placing central lines performed standard SC and IC needle insertion mimicking real-life placement on embalmed cadavers without imaging assistance. Two different latex dyes were used to trace the trajectory of both approaches. After 72 hours, dissections of the insertion areas were performed and a two-person confirmatory system determined the needle and dye penetration of the vessel wall. Biometric data, including subclavian vein width and length, were recorded. Results: Comparison of the SC vs IC approach yielded a non-significant difference between the two sides. However, the left side seems to have a higher chance for IC success. Further, males seemed to have a higher rate of success with the IC approach on the left side compared to females but still non-significant. Conclusion: The SC and IC locations for venous line placement are comparable techniques for addressing hypovolemia, with no significant difference between males and females. Male IC left-side approach showed favorability but due to the sample size, it was not significant. This result could be due to increased breast tissue in females. Follow-up studies are encouraged with larger sample sizes to confirm. Significance/Impact: This study could provide insight into gaining venous access through the different approaches for hypovolemic patients. Subsequent studies on living patients are pertinent to ensure the real-life applicability of this study. Educating medical professionals on this underutilized technique could enhance their knowledge of procedures and lead to the creation of an algorithm for venous line access. Funding/Sources: Kansas City University provided the materials required to complete the study.