Utility of echocardiography during subclavian vein catheterization and the proper length of right subclavian venous catheter in Korea

2004 ◽  
Vol 44 (4) ◽  
pp. S97 ◽  
Author(s):  
H. Kim ◽  
H.S. Kim ◽  
B.S. Oh ◽  
J.H. Kim
2021 ◽  
Vol 8 (3) ◽  
pp. 408-412
Author(s):  
Amit Bodkhe ◽  
Avanti Purohit ◽  
Chitra Pitale ◽  
Hemant Bhirud

The subclavian vein is the preferred site for central venous catheter insertion because of its several advantages. Infraclavicular is the commonly used approach while supraclavicular is less popular approach for catheterizing the subclavian vein. The aim of the study was to compare supraclavicular and infraclavicular approach of subclavian vein catheterization in terms of number of attempts, success rate, access time for catheterization and to record the complications associated with the procedure. In this study, 120 patients of inclusion criteria were placed either in group supraclavicular (SC) or group infraclavicular (IC) for subclavian vein catheterization using modified Seldinger technique under general or local anaesthesia.Chi square test was used to compare success rate and independent T test for access time of catheterization between two groups. First attempt success rate in group SC was 81.66% and in group IC was 66.66%. But overall success rate was 93.33% in group SC, whereas it was 90% in group IC. This was not statistically significant with p value of 0.5. Time taken for successful catheterization was 252.98 ± 76.27 seconds in group SC and 314.98 ± 121.28 seconds in group IC. This was statistically significant with p value of 0.001.Right brachiocephalic vein tear was the only complication in entire study which occurred in group IC. Subclavian vein catheterization via supraclavicular approach was a faster approach than infraclavicular, whereas both were comparable in terms of success rate.


2020 ◽  
Vol 3 (2) ◽  
pp. 111-115
Author(s):  
Robin Khapung ◽  
Jeju Nath Pokharel ◽  
Kiran Kumar KC ◽  
Kripa Pradhan ◽  
Uma Gurung ◽  
...  

Introduction: Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique. Due to anatomical advantage and lesser risk of infection subclavian vein is preferred. Either supraclavicular (SC) or infraclavicular (IC) approach could be used for subclavian vein catheterization. The aim of the study was to compare SC and IC approach in ease of catheterization of SCV and record the complications present if any. Methods and materials: This was a hospital based comparative, interventional study conducted from November 2016 to October 2017 in Operation Theater in Bir Hospital. In this study, 70 patients for elective surgical cases meeting the inclusion criteria were randomly enrolled. Then samples were equally divided by lottery into either supraclavicular or infraclavicular approach groups. The Access time, cannulation success rate, attempts made for successful cannulation of vein, easy insertion of catheter and guide wire, approximate inserted length of catheter and associated complications in both groups were recorded. Data was entered in statistical software SPSS 16. Chi-square test was used. P value < 0.05 was considered significant. Results: The mean access time in group SC for SCV catheterization was 2.12 ± 0.81 min compared to 2.83 ± 0.99 min in group IC (p-value= 0.002). The overall success rate in catheterization of the right SCV using SC approach (34 / 35) was better as compared with group IC (33 / 35) using IC approach. First successful attempt in the SC group was 74.28% as compared with 57.14% in the IC group. Conclusion: The SC approach of SCV catheterization can be considered alternative to IC approach in terms of landmark accessibility, success rate and rate of complications.


2018 ◽  
Vol 2 (3) ◽  
pp. 277-281
Author(s):  
Lalit Kumar Rajbanshi ◽  
Sambhu Bahadur Karki ◽  
Batsalya Arjyal

Introduction: Central venous catheterization is a routine procedure for long-term infusion therapy and central venous pressure measurement. Sometimes, the catheter tip may be unintentionally placed at the position other than the junction of superior vena cava and right atrium. This is called malposition and can lead to erroneous pressure measurement, increase risk of thrombosis, venous obstruction or other life threatening complications like pneumothorax, cardiac temponade.Objectives: This study aimed to observe the incidence of the malposition and compare the same between ultrasound guided catheterization and blind anatomical landmark technique.Methodology: This study was a prospective comparative study conducted at the intensive care unit of Birat Medical College and Teaching Hospital for two-year duration. All the catheterizations were done either with the use of real time ultrasound or blind anatomical landmark technique. The total numbers of central venous catheterization, the total incidences of malposition were observed. Finally the incidences were compared between real time ultrasound guided technique and blind anatomical landmark technique.Results: In two-year duration of the study, a total of 422 central venous cannulations were successfully done. The real time ultrasound was used for 280 cannulations while blind anatomical landmark technique was used for 162 patients. The study observed various malposition in 36 cases (8.5%). The most common malposition was observed for subclavian vein to ipsilateral internal jugular vein (33.3%) followed by subclavian to subclavian vein (27.8%) and internal jugular to ipsilateral subclavian vein (16.7%). In four patients the catheter had a reverse course in the internal jugular vein while the tip was placed in pleural cavity in three cannulations. There was coiling of the catheter inside left subclavian vein in one patient. The malposition was significantly reduced with the use of the real time ultrasound (P< 0.001). However there is no significant difference in the incidence of the various malposition between ultrasound guidance technique and blind anatomical landmark technique when compared individually.Conclusion: The malposition of the central venous catheter tip was common complication with the overall incidence of 8.5%. The most common malposition was subclavian vein to internal jugular vein. The use of real time ultrasound during the catheterization procedure can significantly reduced the risk of malposition.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 277-281


2007 ◽  
Vol 11 (3) ◽  
pp. 149-150
Author(s):  
P. Jain ◽  
J.C. Muthusami ◽  
J.P. Raj* ◽  
P. Gaikwad ◽  
J. Rajinikanth ◽  
...  

Author(s):  
Dr. Sandeep Madaan ◽  
Dr. Lavlesh Mittal

INTRODUCTION: Deep knowledge of anatomy is an essential part of surgical practice. Students of medical sciences gain knowledge and theoretical data through actual visualization of anatomic structures of the cadavers also anatomic relations can be studied more efficiently by practicing on cadavers. As phrenic nerve may be damaged during subclavian vein catheterization the relationship between the phrenic nerve and the subclavian vein is of clinical interest. During the subclavian vein catheterization analogous variable relationships are helpful to explain and prevent damage to the phrenic nerve. MATERIAL AND METHODS: Dissection was started from the root of the neck. No surgical scars, gross anatomical and morphological abnormalities was noted on the cadaver. Measurements were taken during the anatomical dissections.  RESULTS: Of the 36 cadavers dissected in 34 (94.44%) cases phrenic nerve was found posterior to the subclavian vein and in 2(5.56%) cases found anterior to the subclavian vein of which one case was male and the other was female. In the male case in which phrenic nerve was passing anterior to the subclavian vein, it was adherent to the anterior wall of the subclavian vein and was nor piercing the vein wall. CONCLUSION: The cannulating needle may damage the phrenic nerve which is adherent to the subclavian vein. So, the puncture site should be more laterally at the outermost portion of the subclavian vein. Anatomical variants during invasive practical procedures should be always kept in mind. KEYWORDS: phrenic nerve, subclavian vein, phrenic nerve palsy, catheterization.


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