Indications, Management, and Complications of Percutaneous Subclavian Catheters

Brachiocephalic veins: An overlooked approach for central venous catheterization

“…The acute complications of central venous access techniques are directly related to the technique itself (Christensen et al, 1967) and the skill of the operator (Bernard and Stahl, 1971;Herbst, 1978;Buithieu et al, 1996). It is therefore reasonable and even mandatory to make use of alternative or modified techniques, which aim at 1) more simplicity: choosing a more direct route to reach the superior vena cava; 2) more reproducibility: relying on more constant and more easily identifiable anatomical landmarks; and 3) more safety: puncture away from important structures with a short puncture distance and obvious trajectory of advancement into a more wide-bore, patent vessel.…”

“…Complication rates range between 0.1-10% (Seneff, 1991). Acute complications, with an incidence of 7.2%, are incurred during catheter insertion and are basically iatrogenic (Davidson et al, 1963;Yarom, 1964;Yoffa, 1965;Borja, 1972;Ryan et al, 1974;Voegele, 1976;Herbst, 1978;Goutail-Flaud et al, 1991;Yerdel et al, 1991a,b;Ballard et al, 1992).…”

“…Anatomical landmarks that are vague or hard to recognize, anatomical variations, and inexperience of the operator are among the factors causing complications (Bernard and Stahl, 1971;Herbst, 1978;Nehme, 1980;Seneff, 1991). Improper placement of needle/ catheter (6 -8% of total catheterizations; Christensen et al, 1967); incorrect trajectory of advancement of needle/catheter, or advancement of needle/catheter too far, with or without transfixion of the target vein, may injure neighboring structures, resulting in serious acute thoracic, vascular, cardiac, and neurological complications.…”

Nutritional Support in Critical Illness

“…Rates of complications of catheter insertion are somewhat operator-dependent and range up to about six percent [31], including all types of injuries from pneumothorax to thoracic duct injury. In addition, there is a complication rate for maintaining catheters in place including infections, venous thrombosis, arrhythmias, cardiac perforation with tamponade, catheter occlusion and air embolism.…”

Choice of Route for Central Venous Cannulation: Subclavian or Internal Jugular Vein? A Prospective Randomized Study

“…This is largely due to inexperience and/or technical mishaps (5). The relative merits of CVP catheterization by the subclavian or internal jugular route have been discussed in numerous publications (6)(7)(8)(9)(10)(11)(12)(13)(14). Despite the volume of literature on this subject dating back to 1942 (15), we have found no published comparison studies to evaluate which, if either, is the better procedure.…”