Proper Shoulder Position for Subclavian Venipuncture

Kitagawa, Norihito; Oda, Mayuko; Totoki, Tadahide; Miyazaki, Noriaki; Nagasawa, Ichiroh; Nakazono, Takahiko; Tamai, Tsutomu; Morimoto, Masatoshi

doi:10.1097/00000542-200412000-00010

Cited by 37 publications

(11 citation statements)

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“…Turning the head away from the needle puncture site increases the angle of the SCV and IJV, and causes malpositioning in the IJV [8,10]. Lowering the shoulder position reduces the angle between the SCV and innominate vein, and increases the incidence of catheter misplacement into the ipsilateral IJV [9,10]. In the present study, subclavian venous cannulation was performed with the head and shoulders in a neutral position to exclude any positional effect.…”

Section: Discussionmentioning

confidence: 99%

The influence of the direction of J-tip on the placement of a subclavian catheter: real time ultrasound-guided cannulation versus landmark method, a randomized controlled trial

Jeon

Choi

et al. 2014

BMC Anesthesiol

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BackgroundIt has been reported that the direction of the guidewire J-tip is associated with misplacement of a central venous catheter. We hypothesized that real-time ultrasound-guided infraclavicular subclavian venous cannulation would be less influenced by the direction of guidewire J-tip compared to landmark method.MethodsSixty adult patients who required subclavian venous catheterization for neurosurgery were enrolled in this prospective randomized controlled study. Patients were randomly divided into a landmark group (n = 30) or an ultrasound group (n = 30). After the subclavian vein was punctured, the guidewire was advanced with the guidewire J-tip directed cephalad. Misplacement or advancement failure of the guidewire was regarded as an unsuccessful placement. Postoperative chest radiography was performed to confirm pneumothorax and the location of the catheter tip.ResultsThe two groups were comparable with respect to age, gender, height, and weight distribution. The incidence of unsuccessful guidewire placement was lower in the ultrasound group than in the landmark group (13% vs. 47%, P = 0.01). Among the unsuccessful guidewire placements, the incidence of misplacement were comparable between the groups and were all located in the ipsilateral internal jugular vein (7% vs. 7%). However, the incidence of advancement failure was significantly higher in landmark group (40% vs. 7%, P = 0.005). There were no complications such as pneumothorax or hemothorax.ConclusionsThe proper placement of guidewire was less influenced by the direction of the guidewire J-tip with ultrasound-guided subclavian venous cannulation than with the landmark approach.

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Section: Discussionmentioning

confidence: 99%

The influence of the direction of J-tip on the placement of a subclavian catheter: real time ultrasound-guided cannulation versus landmark method, a randomized controlled trial

Jeon

Choi

et al. 2014

BMC Anesthesiol

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“…Catheter insertion through the SCV is frequently performed in the ED, and catheter tip malpositioning should be avoided for improving patient prognosis. Previous studies of SCV catheter insertion mostly focused on factors associated with successful puncture of the SCV, catheterization failure, and positions of the malpositioned catheter tips along with the associated complications [ 1 , 4 , 8 , 19 , 24 , 25 ]. In the present study, we attempted to associate incidences of misplacement with radiographic features of patient shoulders.…”

Section: Discussionmentioning

confidence: 99%

“…A quantitative study of shoulder position based on computed tomography images in the context of catheter misplacement was performed by Kitagawa et al [ 19 ]. They found that a superior-inferior change of 5 cm in shoulder height increased the overlapping area between the clavicle and SCV from 33.5% to 40%, increased the angle between the SCV and IJV from 89° to 117°, and decreased the angle between the SCV and BCV from 114° to 99° in the neutral shoulder position.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported comparisons between misplacement rates and patients’ shoulder positions [ 19 - 21 ]. A recent randomized controlled trial suggested that the neutral position was associated with a reduced misplacement rate, but the preferred shoulder position (lowered, elevated, or neutral) for misplacement prevention remains controversial [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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A quantitative analysis of the relation between the clavicular tilt angle and subclavian central venous catheter misplacement

Jeong

Yoon

et al. 2014

Clin Exp Emerg Med

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ObjectiveThe aim of the present study was to investigate the relation between shoulder position and subclavian central venous (SCV) catheter misplacement. The shoulder position was estimated using clavicular tilt angle (CTA) values observed on anteroposterior chest X-ray images.MethodsA retrospective case-control study was conducted on all adult patients who underwent SCV catheterization in the emergency department during a 12-month period. Collected data included patient age, sex, diagnosis, catheterization side, catheter misplacement, and physician’s level of experience in catheterization. The CTA and other radiological variables such as the ipsilateral transverse length of the thorax and thickness of the clavicle were investigated.ResultsAmong all central venous catheterizations (n=1,599), the subclavian route was used 981 times (61.4%). There were 51 misplacements of SCV catheters (5.2%) during the study period. There were no differences in the sex, age, blood pressure, and diagnosis between the two groups. The CTA values were 28.5°±7.3° and 22.6°±6.3° in the misplacement group and control group, respectively (95% confidence interval, 3.6 to 8.1; P<0.001).ConclusionIn this study, the CTA was found to be 5.9° larger in the misplacement group than in the control group. Assuming that CTA indicates the shoulder position, our findings suggest that the chance of SCV catheter misplacement may be reduced by avoiding the shoulder elevated.

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“…This increases the risk of catheter passing in to 14,15 the internal jugular vein and vice versa. in the same way the angle between the subclavien vein and innominate vein is reduced by lowering the shoulder posi on and this 16 increases the risk of malposi on. Another effec ve method for minimizing the malposi on from subclavian to internal jugular vein is to apply external pressure on IJV during the threading of the guide wire.…”

Section: 85±1170mentioning

confidence: 96%

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

Rajbanshi

Karki

Arjyal

2018

Birat J. Health Sci.

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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

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Proper Shoulder Position for Subclavian Venipuncture

Cited by 37 publications

References 11 publications

The influence of the direction of J-tip on the placement of a subclavian catheter: real time ultrasound-guided cannulation versus landmark method, a randomized controlled trial

The influence of the direction of J-tip on the placement of a subclavian catheter: real time ultrasound-guided cannulation versus landmark method, a randomized controlled trial

A quantitative analysis of the relation between the clavicular tilt angle and subclavian central venous catheter misplacement

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

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