Supraclavicular approach to the subclavian vein – one well forgotten technique with impressive results

2019 ◽  
Vol 91 (3) ◽  
pp. 1-5
Author(s):  
Biser Borisov ◽  
Sergey Iliev
Keyword(s):  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Statistical Correlation ◽  
Central Vein ◽  
Chronic Complications ◽  
Supraclavicular Approach ◽  
Acute Complications ◽  
Vein Stenosis ◽  
Central Vein Stenosis

Purpose: Insertion of temporary and tunneled catheters for hemodialysis in the internal jugular vein is a gold standard. On the other hand, the supraclavicular approach to the subclavian vein is described by Yoffa in 1965. Despite its old invention, the latter technique is well forgotten for unknown reasons. The aim of this study is to present our experience with the usage of the supraclavicular approach for insertion of temporary and tunneled catheters. Material and Methods: We provide our experience on insertion of 506 temporary and 501 tunneled catheters within a five-year period (from 1st January 2010 to 31st December 2014). We use 8 (eight) different places for catheters insertion, including the subclavian vein by the supraclavicular approach following the techniques of D. Yoffa and J. Gorchynski. The collected data include age, sex, reasons for hemodialysis, number of attempts for successful cannulation, number of acute (AC) and chronic (CC) complications, and dependence on the catheter insertion location. Results: The gender distribution shows 463 (46 %) women and 544 (54 %) men with median age of 60.0 (+/- 13.2) years. In the cases of temporary catheters: 104 (20.5%) are inserted in the subclavian vein by the supraclavicular approach (SCVSC), 70 (13.8%) – in the internal jugular vein (IJV); in the cases of tunneled ones – SCVSC – 281 (56%), and IJV – 207 (41%) catheters, respectively. We found significant statistical correlation (p < 0.05 and r = 0.23) between the acute complications and the insertion position – AC are more for IJV insertion, than in SCVSC. We did not find significant correlation between the insertion place and the chronic complications. Even central vein stenosis is more frequent in the IJV than in the SCVSC, but this is not significant (p > 0.05). Primary catheter patency of temporary and tunneled catheters is higher when they are inserted in the left veins. Conclusion: We conclude that the supraclavicular approach to the subclavian vein is easier, safer and a practically more convenient method than the cannulation of the IJV. The revisit of this approach demonstrates that it should be more widely used.

scholarly journals HEAMODIALYSIS PATIENTS;

2017 ◽  
Vol 24 (08) ◽  
pp. 1211-1215
Author(s):  
Aurangzeb Afzal ◽  
Anwar Ulhaq ◽  
Aizazmand Ahmed ◽  
Wasif Baig ◽  
Adnan Zafa ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Color Doppler ◽  
Cross Sectional Study ◽  
P Value ◽  
Central Vein ◽  
Double Lumen ◽  
Cross Sectional ◽  
Vein Stenosis ◽  
Central Vein Stenosis

Background: Internal jugular vein is considered the preferred site of insertion.Prevalence of central vein stenosis following temporary double lumen catheterization at differentsites seems to be different in Asian countries. Objectives: To evaluate the number of cases havingcatheterization and stenosis after being subjected to central vein catheterization (CVC) amongPakistani population. Study Design: Cross sectional study. Period: 6 months period. Setting:Admitted in the Department of Nephrology or already undergoing maintenance hemodialysisfulfilling the inclusion criteria were included in the study. Material and Method: The samplewhich was considered suitable for this study was 150 cases after checking the inclusion criteriacarefully. The patients were advised to undergo color Doppler ultrasonography of IJV and SCVof both sides. Demographics and outcome variables were noted and recorded for the analysispurposes. Data was analyzed used SPSS 20.inc Results: The frequency of catheterization ofcatherization at IJV was found to be 128(85.3%) and frequency of catheterization at SCV was22(14.7%). The frequency of CVS at IJV was found to be 43(29.68%) and the frequency of CVSat SCV was 81(54.54%). The frequency of stenosis at SCV was found to be significantly higherwith a p value of 0.029 (<0.05). Conclusion: Internal jugular vein is the most frequent andpreferred site of temporary double lumen catheterization for haemodialysis as it is associatedwith significantly lower rate of stenosis as compared to subclavian vein.

Ultrasound aided repositioning of misplaced guidewire during subclavian vein catheterisation

2019 ◽  
Vol 20 (6) ◽  
pp. 769-770
Author(s):  
Ferdinando Longo ◽  
Chiara Piliego ◽  
Felice E Agrò
Keyword(s):  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Central Vein ◽  
Common Complication ◽  
Ultrasound Guided

Catheter misplacement is a common complication during central vein catheterisation, and during subclavian vein catheterisation, one of the most common misplacements of the catheter is the ipsilateral internal jugular vein. Facing this type of misplacement, we tried to find an ultrasound-guided method to reposition the guidewire during subclavian vein catheterisation in adults.

scholarly journals A Comparison of Outcomes and Complications of Totally Implantable Access Port Through the Internal Jugular Vein Versus the Subclavian Vein

2014 ◽  
Vol 99 (2) ◽  
pp. 182-188 ◽  
Author(s):  
Yoshinobu Nagasawa ◽  
Tomoharu Shimizu ◽  
Hiromichi Sonoda ◽  
Eiji Mekata ◽  
Masato Wakabayashi ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Statistical Significance ◽  
Late Complication ◽  
Insertion Site ◽  
Multivariate Logistic Regression Analysis ◽  
Late Complications ◽  
Complication Rates ◽  
Access Port

Abstract Totally implantable access ports (TIAPs) are generally used in oncology. Few studies have addressed complications associated with the insertion site. A total of 233 consecutive oncology patients were enrolled to receive TIAP inserts via internal jugular vein (IJV) or subclavian vein (SV). Data on clinicopathologic parameters and early/late complications were retrospectively collected. No differences were found early and late complication rates. Catheter injury was observed more frequently in the IJV group (2.9%) than in the SV group (1.0%) without statistical significance. Multivariate logistic regression analysis showed that age, switch to palliative use of TIAP, and the distribution of diseases (low risk in patients with colorectal cancer) were independent risk factors for determining complications. In conclusion, TIAP insertion site showed no impact on the early and late complication rates. Catheter injury appears to occur at the same frequency with both approaches. Therefore, medical doctors may choose their preferred puncture site when performing TIAP insertion.

The Morphology and Hemodynamic Characteristics of Patients with Internal Jugular Vein Stenosis

2021 ◽  
Vol 5 (2) ◽  
pp. 73
Author(s):  
Jia, MD Lingyun ◽  
Hua, MD Yang ◽  
Ji, MD Xunming ◽  
Zhang, MD Kaiyuan ◽  
Li, MD Shengnan ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Hemodynamic Characteristics ◽  
Vein Stenosis

scholarly journals A Study of Malposition of Central Venous Catheter – A Comparative Study between Ultrasound Guided and Anatomical Landmark Technique

2018 ◽  
Vol 2 (3) ◽  
pp. 277-281
Author(s):  
Lalit Kumar Rajbanshi ◽  
Sambhu Bahadur Karki ◽  
Batsalya Arjyal
Keyword(s):  
Real Time ◽  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Venous Catheter ◽  
Anatomical Landmark ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Catheter Tip ◽  
Landmark Technique

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

Transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access

2018 ◽  
Vol 20 (5) ◽  
pp. 488-494 ◽  
Author(s):  
Jin Ho Kim ◽  
Sung Bum Cho ◽  
Yun Hwan Kim ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Internal Jugular Vein ◽  
Patency Rate ◽  
Jugular Vein ◽  
Hemodialysis Access ◽  
Procedure Time ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean ◽  
Vein Stenosis

Purpose: To evaluate the feasibility and the outcomes of transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access in patients with chronic kidney disease. Methods: A total of 50 transjugular treatments in 38 patients with arteriovenous fistulas or arteriovenous grafts from September 2011 to May 2015 were included in this study. Medical records and angiographies were retrospectively reviewed. Success rate, patency rate, procedure time, and complications including internal jugular vein stenosis were evaluated. Results: A total of 50 sessions of transjugular treatments were performed in 38 patients. There were 31 native arteriovenous fistulas including 10 immature cases and 19 arteriovenous grafts. Among the 50 cases, technical success was achieved in 45 and clinical success was achieved in 44; 37 cases (74%) with multiple stenotic sites were treated by the transjugular approach without placement of cross-sheaths. The mean time from puncture of the internal jugular vein to first fistulography was 10 min, and the mean total procedure time was 64 min. The primary patency rate at 6 months was 77%, while the secondary patency rate at 6 months was 97%. Perforation occurred in two cases during conventional percutaneous transluminal angioplasty after failure of the transjugular approach. One dissection occurred during the transjugular approach. There was no newly developed internal jugular vein stenosis during a mean follow-up period of 19.3 months. Conclusion: For the treatment of dysfunctional or immature hemodialysis access, the transjugular approach is a feasible and effective option that avoids injury to the graft or draining vein, especially in immature fistulas.

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