Central venous cotheterization in open heart surgery: internal jugular vein or supraclavicular subclavian vein approach?

Background: In this Study we investigated the factors that affect the development of complications in patients who had central venous catheter (CVC) insertion. Methods: Ninety-four Patients (69 males, 25 females mean age 60.3 +/- 13.2 years: range 4 to 84 years) who had CVC between November 2007 - January 2009 in our clinic were investigated prospectively. Patients were randomized to two groups; in group 1 (n=49), CVC was performed through right internal jugular vein (IJV), and in group 2 (n=45). CVC was performed through right supraclavicular subclavian vein (SpSV). All of the CVC's were performed by means of Seldinger's technique by the same operator. Results: There were no significant differences in the demo-goraphic features between the two groups. There were no significant differences between the groups With regard to pneumothorax, hemothorax, malposition. hematoma development, neurological damage, infection and catheter stay in the intra- and postoperative periods. Nine cases had arterial puncture [group 1 (n=8) and group 2 (n=1) p=0.020]. seven cases had pinch-off phenomenon [group 1 (n=0) and group 2 (n=7); p=0.004], and 19 cases had two or more interventions [group 1 (n=16) and group 2 (n=3); p=0.002]. In the multivariate analysis, the powerful predictive factor for arterial Puncture was the body mass index (BMI) (p=0.028). for the pinch-off phenomenon BMI (p=0.040) and the SpSV approach (p=0.022); the predictive factor for two or more insertional attempts was IJV approach (p=0.007). Conclusion: The patient's anatomy, BMI and the physician's experience should be considered for a successful attempt. We think that SpSV catheterization may be among the preferences.