
==== Front
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-10071-24732
Letter to the Editor
Author Response: Shifting Paradigms in Vascular Access: A Deep Dive into the Supraclavicular Approach's Uncharted Waters
Jaiswal Pooja 1https://orcid.org/0000-0003-2322-3728

Chhabra Priyanka H 2https://orcid.org/0000-0001-9436-6123

Saini Suman 3https://orcid.org/0000-0001-9436-6123

1–3 Department of Anaesthesiology, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
Priyanka H Chhabra, Department of Anaesthesiology, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India, Phone: +91 9910137941, e-mail: priyankahsinghani@gmail.com
6 2024
31 5 2024
28 6 624624
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: Jaiswal P, Chhabra PH, Saini S. Author Response: Shifting Paradigms in Vascular Access: A Deep Dive into the Supraclavicular Approach's Uncharted Waters. Indian J Crit Care Med 2024;28(6):624.

Keywords

Infraclavicular approach
Procedural efficacy and safety
Supraclavicular approach
==== Body
pmcDear Editor,

We appreciate the response to our study by Bouazizi YE, et al.1 We gladly received this opportunity to answer their queries and clarify further on our findings.

Our study demonstrated the superiority of the supraclavicular technique in terms of lower total procedural time, visualization time, puncture time, and catheter insertion time when compared to the infraclavicular technique. Better ultrasound view scores, higher first attempt-success rate, and fewer complications were demonstrated with the supraclavicular route.

First of all, multiple attempts were defined as more than three attempts of needle insertion and were considered as failures. Patients with multiple attempts were not included in the analysis as per our study protocol. We observed two such patients in the supraclavicular group while the infraclavicular group had three patients with multiple attempts. Since, multiple attempts lead to distortion of ultrasonographic anatomy, thereby, making subsequent attempts more difficult and time-consuming. The inclusion of these cases would lead to the skewed distribution of data and interfere with the interpretation of study findings.

Secondly, the procedure for subclavian central line insertion was performed by a single anesthesiologist who had previous experience of at least 20 central line cannulations with either technique under ultrasound guidance. This was to minimize confounding variables such as the variability of practitioners and the skill of the anesthetist in performing the procedure.

Thirdly, we clarify that our study included subclavian vein catheterization using ultrasound guidance in adult patients who were mechanically ventilated under general anesthesia. Further, we suggest more randomized controlled trials are needed in the future to establish the safety and efficacy of adapting the supraclavicular route of subclavian vein cannulation by broad specialty practitioners and for indications other than central line cannulation.

Our study findings were analogous to conclusions drawn by Ravikumar RH, et al. that the supraclavicular route to subclavian vein catheterization under ultrasound guidance indeed reduces the total procedure time with a higher first-attempt success rate.2 Similar inferences were drawn in a recent meta-analysis by Imai E, et al.3 We conclude that USG guided supraclavicular approach to access the subclavian vein is a quicker and relatively more secure technique than the infraclavicular approach.

Lastly, we agree with Bouazizi YE, et al. that further studies are required to establish the supraclavicular route of subclavian vein catheterization as a clinically preferred approach in terms of learning curve, long-term benefits, and patient comfort. We appreciate their engagement with our study and welcome further discussion and collaboration to advance our understanding of the cannulation technique.

Orcid

Pooja Jaiswal https://orcid.org/0000-0003-2322-3728

Priyanka H Chhabra https://orcid.org/0000-0001-9436-6123

Suman Saini https://orcid.org/0000-0001-9436-6123

Source of support: Nil

Conflict of interest: None
==== Refs
References

1. El Bouazizi Y Ghannam A Souadka A Shifting paradigms in vascular access: A deep dive into the supraclavicular approach's uncharted water Indian J Crit Care Med 2024 28 6 622 623 39130388
2. 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 10.1177/11297298241239092
3. Imai E Watanabe J Okano H Yokozuka M Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterization: An updated systematic review and meta-analysis of randomised controlled trials Indian J Anaesth 2023 67 6 486 496 10.4103/ija.ija_837_22 37476443
