An ultrasound-guided supraclavicular approach for tunneled central venous catheter insertion can be safely performed by junior residents
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In brief
In brief
This study demonstrates that junior surgical residents can safely perform ultrasound-guided supraclavicular insertion of tunneled central venous catheters via the brachiocephalic vein, with complication rates comparable to experienced surgeons despite longer operative times. The supraclavicular approach offers improved visualization and may be a teachable alternative to traditional internal jugular techniques for long-term venous access.
- Ultrasound-guided supraclavicular approach to the brachiocephalic vein offers superior visualization for tunneled CVC insertion.
- Junior residents achieved comparable complication rates to senior surgeons (no significant difference in arterial puncture or pneumothorax).
- Operation time was longer for junior residents but safety profile remained acceptable with proper case selection.
- Overall complication rate was low: 6 arterial punctures, 1 pneumothorax, 1 hemothorax in 177 procedures across all experience levels.
- Supervised junior residents can safely perform this technique with attention to arterial and pleural injury risk.
Written by the GCMD Library team from the article.
Abstract
Purpose
Ultrasound-guided supraclavicular catheterization (UGSC) of the brachiocephalic vein (BCV) for long-term tunneled central venous catheter (tCVC) insertion may be safer than the internal jugular vein approach due to its superior field of view. We examined the clinical outcomes of tCVC insertions performed by junior residents through UGSC of the BCV.
Patients and methods
From January 2018 to December 2023, we assessed clinical outcomes and compared the experience levels of surgeons conducting tCVC insertions. Surgeons were categorized into three groups: junior residency (JR), senior residency (SR), and board-certified pediatric surgeons (BCPS).
Results
177 tCVC insertions were done on 146 patients. Intraoperative complications included 6 cases of arterial puncture, 1 case of pneumothorax, 1 case of over insertion of catheter tip, and 1 case of suspected hemothorax. Distribution across groups was as follows: 28 cases (15.8%) in JR group, 92 (52.0%) in SR group, and 57 (32.2%) in BCPS group. Although the JR group exhibited longer operation times than the BCPS group, no significant differences in intraoperative complications were noted.
Conclusion
Junior residents can safely perform UGSC for tCVC insertion. However, careful consideration of complications such as arterial or thoracic puncture is essential and case selection should be based on experience.