Extract:
“We read with great interest the post hoc target trial emulation by Boulet, et al., which utilized 3SITES data to compare the incidence of catheter-related infectious, thrombotic, and mechanical complications among internal jugular, femoral, and subclavian sites, assuming universal real-time ultrasound guidance. They showed that in a total of 989 catheters in the subclavian site, only 50 (5.1%) catheterizations were real-time ultrasound-guided. This means that in their original 3SITES trial, most of subclavian vein catheterizations were landmark-based, which was associated with a higher risk of immediate mechanical complications. In contrast, real-time ultrasound can overcome the drawbacks of the landmark-based subclavian vein access technique and improve its risk-benefit profile. As their current target trial emulation suggests, the incidence of major mechanical complications was markedly lower than that observed in the original trial. In an early study from Fragou et al., real-time ultrasound-guided subclavian catheterization (n = 200) achieved a 100% success rate and decreased artery puncture rate to 0.5%, with no pneumothorax and hemothorax, in contrast with landmark-based method (n = 201) of 87.5% success rate and three complications rate of about 5%, respectively. Another recent randomized controlled trial (n = 449) demonstrated a 99.1% success rate with a 1.1% rate of artery puncture and no cases of pneumothorax.”
Reference:Zhang X, Zhang R. Real-time ultrasound-guided subclavian vein cannulation: should it be the preferred method for central venous catheterization in critically ill? Crit Care. 2025 Dec 31;29(1):541. doi: 10.1186/s13054-025-05824-7. PMID: 41476201; PMCID: PMC12756923.