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Indian J Crit Care Med
Indian J Crit Care Med
IJCCM
Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
0972-5229
1998-359X
Jaypee Brothers Medical Publishers

10.5005/jp-journals-10071-24715
Letter to the Editor
Shifting Paradigms in Vascular Access: A Deep Dive into the Supraclavicular Approach's Uncharted Waters
El Bouazizi Yassine 1https://orcid.org/0000-0002-3834-4701

Ghannam Abdelilah 2https://orcid.org/0000-0003-2630-7898

Souadka Amine 3https://orcid.org/0000-0002-1091-9446

1,3 Department of Surgical Oncology, National Institute of Oncology, Mohammed V University, Rabat, Morocco
2 Department of Anesthesia and Critical Care Mohammed V University, Rabat, Morocco
Amine Souadka, Department of Surgical Oncology, National Institute of Oncology, Mohammed V University, Rabat, Morocco, Phone: +212666953668, e-mail: a.souadka@um5r.ac.ma
6 2024
31 5 2024
28 6 622623
Copyright © 2024; The Author(s).
2024
https://creativecommons.org/licenses/by-nc/4.0/ © The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
How to cite this article: El Bouazizi Y, Ghannam A, Souadka A. Shifting Paradigms in Vascular Access: A Deep Dive into the Supraclavicular Approach's Uncharted Waters. Indian J Crit Care Med 2024;28(6):622–623.

Keywords

Infraclavicular approach
Procedural efficacy and safety
Supraclavicular approach
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pmc To the Editor,

We read with great interest the recent article by Jaiswal et al., detailing a prospective randomized comparison of supraclavicular (SC) and infraclavicular (IC) approaches for subclavian vein cannulation.1 This study significantly enriches our understanding, offering critical insights and encouraging a broader discourse on vascular access techniques.

Noteworthy is the study's demonstration that the SC approach, guided by ultrasonography, markedly reduces both the total procedural time and the specific durations required for vein visualization and puncture compared with the IC method. This efficiency, coupled with a superior first-attempt success rate and enhanced ultrasound view scores, firmly underscores the SC approach's efficacy. Moreover, the observed reduction in both immediate and subsequent complications with the SC technique advocates for its safer application in elective surgical contexts.2

However, the article omits details on the exclusion of patients necessitating multiple cannulation attempts, a criterion considering such attempts as procedural failures. This omission raises questions about the potential impact of these exclusions on the study's findings and conclusions. Reporting the number of excluded patients is essential for understanding the true failure rate of each technique, which directly informs clinical decision-making and procedural guidelines.

One aspect that warrants closer examination is the experience of anesthesiologists with the SC approach. Given the prevalent preference for the IC method among anesthesiologists due to familiarity and comfort, it raises questions about the learning curve and adaptability required for the SC approach.3 How many different anesthesiologists were involved in the procedures, and what was their prior experience with the SC technique?

Furthermore, the findings echo those reported by Souadka et al., indicating similar outcomes with the SC approach performed by surgeons, not only in mechanically ventilated patients but also in non-ventilated patients or when inserting a totally implantable venous access device (TIVAD).4 This universality of application suggests a broader applicability of the SC approach than previously considered, even by other types of practitioners.

A special technical note of interest is the puncture site's proximity to the clavicle, as per the Yoffa technique,5 which appears to increase the vein's diameter available for cannulation, thereby reducing the risk of arterial puncture. Moreover, this approach potentially minimizes discomfort postextubation and likely offers esthetic benefits, though it necessitates a learning curve for echography-guided punctures with clavicular obstruction.

These findings compellingly advocate for a reevaluation of procedural preferences towards the SC approach for subclavian vein access, highlighting the importance of proficiency with ultrasound guidance in optimizing outcomes and minimizing complications.3

In conclusion, we extend our appreciation for the comprehensive and nuanced analysis provided by Jaiswal et al. We advocate for further research into the learning curve associated with the SC approach, as well as its long-term benefits, particularly regarding patient comfort and cosmetic outcomes. Such studies are essential to conclusively establish the SC approach's preferential status in specific clinical scenarios.

Orcid

Yassine El Bouazizi https://orcid.org/0000-0002-3834-4701

Abdelilah Ghannam https://orcid.org/0000-0003-2630-7898

Amine Souadka https://orcid.org/0000-0002-1091-9446

Source of support: Nil

Conflict of interest: None
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References

1. Jaiswal P Saini S Chhabra PH Subclavian vein cannulation via supraclavicular or infraclavicular route which is better? A prospective randomized controlled trial Indian J Crit Care Med 2024 28 4 375 380 10.5005/jp-journals-10071-24686 38585307
2. Prasad R Soni S Janweja S Rajpurohit JS Nivas R Kumar J Supraclavicular or infraclavicular subclavian vein: Which way to go- A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance Indian J Anaesth 2020 64 4 292 298 10.4103/ija.IJA_930_19 32489203
3. Hosur Ravikumar R Majage S Prasanna M Ray BR Comparison of ultrasound guided supraclavicular subclavian vein versus infraclavicular subclavian/axillary vein catheterization: A systematic review and meta analysis J Vasc Access 2024 20 11297298241239092 10.1177/11297298241239092
4. Souadka A Essangri H Boualaoui I Ghannam A Benkabbou A Amrani L et al. Supraclavicular versus infraclavicular approach in inserting totally implantable central venous access for cancer therapy: A comparative retrospective study PLoS One 2020 15 11 e0242727 10.1371/journal.pone.0242727 33232361
5. Ricci A Majbar A Subclavian vein portacath placement – The Yoffa supraclavicular technique J Visc Surg 2011 148 2 e117 e120 10.1016/j.jviscsurg.2011.03.002 21481667
