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The Brachiocephalic Vein as a Safe and Viable Alternative to Internal Jugular Vein for Central Venous Cannulation

Beccaria, Paolo Federico, MD*; Silvetti, Simona, MD; Lembo, Rosalba, MSC*; Landoni, Giovanni, MD*; Monti, Giacomo, MD*; Zambon, Massimo, MD; Mamo, Daniela, MD*; Zangrillo, Alberto, MD§

doi: 10.1213/ANE.0000000000003357
Critical Care and Resuscitation: Original Clinical Research Report

BACKGROUND: Although many studies have compared success and complication rates for central line insertion sites with and without ultrasound, few have examined the use of the brachiocephalic vein for central venous access. The aim of this study was to describe the brachiocephalic vein as an alternative site for elective ultrasound vascular cannulation in adults, and to compare it with the more commonly used internal jugular vein site in terms of procedural difficulties, first pass failure rate, overall failure rate, and safety.

METHODS: In this single-center, retrospective cohort study, clinical data from consecutive adult patients undergoing elective ultrasound-guided central venous catheterization of upper body were retrieved from the department database. All of these central venous catheters were requested by department team, none was positioned for surgery. Seven hundred nine patients underwent central venous catheterization via the internal jugular approach and 285 patients via the brachiocephalic route. Patients catheterized via the brachiocephalic vein approach were then compared with those catheterized via the internal jugular vein in terms of ease of catheterization, success rate, and complications. Differences between approaches were assessed by univariate analyses and multivariable analysis.

RESULTS: Overall, 994 patients underwent central venous catheterization. A total of 87% had a successful catheter implantation at the first attempt, 6.7% of insertions were difficult, 5.7% were complicated, and 3.4% failed. Procedural difficulty was more frequent with the internal jugular than with the brachiocephalic approach (odds ratio, 0.38; 95% confidence interval, 0.19–0.76; P = .007) after correction for potential confounders. Differences between groups in complication rate (6.3% vs 4.1%) or failure rate (3.4% vs 3.5%) were not significant.

CONCLUSIONS: Brachiocephalic cannulation is a reasonable alternative to ultrasound-guided internal jugular vein catheterization.

From the *Department of Anaesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina, Milan, Italy

Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy

Department of Anaesthesia and Intensive Care, Ospedale Uboldo, ASST Melegnano-Martesana, Cernusco sul Naviglio, Milano, Italy

§Department of Anaesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.

Published ahead of print April 19, 2018.

Accepted for publication February 26, 2018.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Paolo Federico Beccaria, MD, Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132 Italy. Address e-mail to

© 2018 International Anesthesia Research Society
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