Ultrasound-Guided Supraclavicular Brachiocephalic Vein versus Internal Jugular Vein Cannulation in Adults: A Prospective Observational Comparison of Procedural Efficiency and Safety

Background: Ultrasound guidance is recommended as the standard of care for central venous catheterization (CVC) owing to improved first-pass success and reduced mechanical complications. While the internal jugular vein (IJV) remains the most commonly used access site, the supraclavicular brachiocephalic vein (BCV) has emerged as an alternative with favorable anatomical and sonographic characteristics. Prospective comparative adult data remain limited.

Methods: This prospective observational study included 88 adult elective surgical patients requiring central venous access. Patients were alternately allocated to ultrasound-guided in-plane IJV cannulation (n = 44) or ultrasound-guided in-plane supraclavicular BCV cannulation (n = 44). Primary outcomes were vein localization time, puncture time, catheter insertion time, and number of needle attempts. Secondary outcomes included first-pass success and early mechanical complications within 24 hours.

Results: Compared with IJV cannulation, BCV cannulation was associated with significantly shorter vein localization and puncture times, fewer needle attempts, and a higher first-pass success rate. Catheter insertion time was comparable between groups. Two minor hematomas occurred in the IJV group; no arterial puncture, pneumothorax, or hemothorax was observed in either group.

Conclusions: In experienced hands, ultrasound-guided supraclavicular BCV cannulation appears to be an efficient and safe alternative to ultrasound-guided IJV cannulation in adults.