Optimal Length of Insertion of Right Subclavian Venous Catheter via Supraclavicular Approach: A Prospective Observational Study

Authors: Avirneni Vaishnavi, Vipul K Sharma

Keywords: Central venous catheter, Supraclavicular subclavian vein, Anatomical landmarks, Transesophageal echocardiography, Catheter tip placement, Chest radiography

Abstract: Background : Central venous catheterization (CVC) is a routine procedure in perioperative and intensive care. The subclavian vein is frequently selected due to its anatomical consistency and lower infection rates. Although the supraclavicular approach is less common, it offers a straighter course to the superior vena cava (SVC) and potentially reduces complications. Ensuring the catheter tip lies near the SVC - right atrium (RA) junction is vital. This study evaluated the accuracy of a surface landmark-based method for catheter placement, verified by transesophageal echocardiography (TEE) and chest radiography. Methods : A prospective observational study was conducted over six months in a tertiary care center. Ninety-six adult patients (ASA II-III), scheduled for elective surgeries with intraoperative TEE, were enrolled. Exclusion criteria included consent refusal, anatomical abnormalities, local infections, and coagulopathies. The right subclavian vein was accessed via the supraclavicular route. Insertion depth was estimated using surface measurements from the puncture site to the angle of Louis. Tip position was assessed by TEE (bicaval view) and postoperative chest radiographs, using the carina as a reference point. Tips within 1 cm above or below the SVC-RA junction or carina were considered correctly placed. Results : Among the 96 participants (60 males, 36 females; mean age 49.16±16.19 years), catheter insertion depths ranged from 10.0 to 14.0 cm, with a mean of 12.47±0.71 cm. Chest X-ray confirmed appropriate placement in all patients. TEE showed optimal placement in 91.7% (88 cases), while 8 tips were outside the desired zone. One-sample t-tests showed significant differences from zero (p < 0.001) for catheter length and TEE-confirmed tip distance. No complications were observed. Conclusion : The anatomical landmark based technique for supraclavicular subclavian CVC insertion offers reliable tip positioning near the SVC-RA junction. This method is a practical and effective alternative, particularly in settings lacking ultrasound guidance.