Ultrasound-guided subclavian vein cannulation (SUGAR)

Subclavian vein cannulation under Ultrasound Guidance with Advanced Retention: an implementation science approach

The Agency for Healthcare Research and Quality (AHRQ) has classified ultrasound guidance in central line placement as one of the 11 most important safety practices to prevent procedural errors and adverse events. Despite strong evidence and support from national organizations, emergency physicians underutilize ultrasound-guided subclavian vein cannulation (UGSCv). Although acknowledging the patient safety benefits, emergency medicine physicians are unable to mitigate several important barriers toward the widespread adoption of UGSCv cannulation. In previous work, we conducted a quantitative survey demonstrating that our emergency physicians preferentially choose other central venous catheterization sites besides SCv and identified some quantified barriers. Prior efforts to routinely increase UGSCv cannulation during central venous catheter (CVC) insertion have failed for decades. We now turn to an implementation science approach to develop an implementation plan with evidence-based strategies to increase the adoption of UGSCv CVC insertion in the ED. More in-depth qualitative studies are needed to understand the context and relationships for and between barriers to develop and evaluate implementation plans (with implementation strategies) to mitigate barriers and leverage facilitators for physicians to choose UGSCv CVC insertion.