In the emergency room, ultrasound guidance was proven to reduce complication rates and enhance success rates for the internal jugular and femoral vein catheterization (ED). For a study, researchers sought to see if ultrasound-guided subclavian vein catheterization was safer and more effective than the standard landmark approach. A prospective randomized experiment was done in an urban tertiary care academic ED with an annual census of more than 50,000 patients from April 2004 to June 2009. There were 4 main data endpoints: overall success for both residents and attending physicians; the number of attempts by each set of providers; complication rate with each approach; and time to get the subclavian line. A total of 85 patients were enrolled in the research. Compared to the landmark method, the ultrasound method was more successful in obtaining subclavian catheter placement. When successful cannulation attempts in both groups were evaluated, the ultrasound group took a statistically significantly longer time to succeed than the landmark group. Between residents and attending physicians, there was no difference in success or complication rates. The incidences of problems were not significantly different between ultrasound-guided and landmark techniques. In an emergency department scenario, ultrasound-guided subclavian vein catheterization was found to have a greater overall success rate than the landmark approach, with no significant difference in complication rate.
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