الفهرس 
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Abstract
A central venous catheter (CVC) is an indwelling device that is placed into the major central vein from the periphery. Total parenteral nutrition (TPN) delivery, plasmapheresis, dialysis, hemodynamic monitoring, drug administration, and the facilitation of subsequent sophisticated treatments, such as transvenous pacemaker insertion, all need the use of specialized access methods and equipment.
Subclavian venous catheterization may be performed by either an infraclavicular or supraclavicular route.
Two hundred and ten patients receiving ultrasound-guided right subclavian venous catheterization for major elective surgery or intensive care unit admission were randomly divided into a supraclavicular (n = 105) and infraclavicular (n = 105) group.
As a main objective, we looked at how simple it was to get a catheter, how many times needles had to be stuck into a patient, and how long it took.
Mechanical problems (arrhythmia, arterial puncture, haematoma formation, and pneumothorax ) and catheter misplacement are also measured as secondary outcomes.
Our results showed that
As regard accessibility we noticed that using ultrasonography device has increase 1st pass success rate and low number of failure rate regardless BMI. And The infraclavicular method had a greater percentage of successful first- time puncture .about 75% and 53.3% for supraclavicular group with p value
=.003 which is significant
In the Supraclavicular approach 83 (79%) cases successed in less than 3 min and 22 (21%) cases needed more than 3 min and in the infraclavicular approach 94 (89.5%) cases successed in less than 3 min and 11( 10.5%) cases needed more than 3 min .
We found that 135 cases have been successed from the first puncture regardless the weight .
For subclavian venous puncture and catheterization the number (proportion) of patients with catheterization-related complications was 20 (9.5%) in the supraclavicular group and 6 (2.5%) in the infraclavicular group
As regard arrhythmia ,In the Supraclavicular approach there were 6 (5.7 %) of cases had developed arrhythmia .and in the infraclavicular approach only 2 (1.9%) cases developed arrhythmia
As regard arterial puncture In the Supraclavicular approach there were 6 (5.7
%) of cases had developed arterial puncture .and in the infraclavicular approach only 1 (1%) case .
As regard misplacement ,In the Supraclavicular approach there were 2 (1.9
%) of cases had developed misplacement , .and in the infraclavicular approach only 1 (1%) case
As regard haematoma formation ,In the Supraclavicular approach there were 3 (2.9 %) of cases had developed haematoma ,and in the infraclavicular approach no cases .
As regard post catheterization infection ,In the Supraclavicular approach there were 3 (2.9 %) of cases had developed infection on the site of CVC insertion , and in the infraclavicular approach no cases .
And as regard pneumothorax ,In the Supraclavicular approach there were no cases had developed pneumothorax after CVC insertion ,and in the infraclavicular approach 2 (1.9%) cases complicated with pneumothorax
The infraclavicular group is more accessible and with lower rate of complication than the supraclavicular approach.
• In conclusion
Successful catheterization rates and times were roughly same between the two methods. For ultrasound-guided right subclavian venous catheterization, however, the infraclavicular technique is preferred over the supraclavicular one. Due to higher chance of 1st pass success rate and lower rate of complications related in the infraclavicular group
Also take in consideration that choice of approach is depending on the participants experience and the number of cases that he had practiced and the approach that he is familiar with . Also, the more visualized vein according every patient circumstances.
Recommendations
Apply the study for a larger mass size of patients to get better and accurate results as regard ease of accessibility and rate of complication to avoid bias and due to wide range of results .
More prospective, randomized clinical studies applied on emergency unstable patients to compare results.
Conducting a further specific study on obese patients with BMI >30 to know if it affect the accessibility or not
Long term follow up for the patients to study secondary complications as infection and thrombosis formation after CVC insertion.