| Supraclaviculsr Subclavian Vein Catheterization . |
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Jae Kyu Jeon |
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Department of Anesthesiology, Daegu Presbyterian Medical Center, Daegu, Korea. |
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| Abstract |
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Central venous pressure is an extremely useful parameter in the effective monitoring of patients who are seriously ill.
Since the subclavian venepuncture for central venous pressure was introduced by Ashbough in 1963, it has become extremely useful for prolonged intravenous administration of fluids, for a reliable intravenous route in cases of peripheral vascular collapse, and for hyperalimentation.
Since then several different techniques for large vein puncture i.e., subclavian vein and internal jugular vein, have been developed. Since 1974, 265 cases of catheterizations have been recorded by the anesthesia department in the Dong San Medical Center. These were performed mostly by the supraclavicular approach. We have observed the following advantages of this approach over the infraclavicular approach. 1) More definitive skin landmark.
2) The distance between the skin and the vein is shorter. 3) The direction of the needle is easily controlled. 4) There is less tissue trauma because the pectoralis major muscle is not penetrated. 5) There is less incidence of pneumothorax or hydrothorax. 6) The procedure can be performed during surgery by an anesthesiologist. 7) The failure rate is lower. The subclavian vein is located within the costo-clavicular-scalene triangle and is approximately 3 to 4 cm long and 1 to 2cm in diameter in adults. The patient is placed in a supine and Trendelenberg position to allow the subclavian vein to distend and to help prevent air embolization when the vessel is cannulated. Following preparation of the supraclavicular fossa, a 16 gauge needle with a 10cc syringe attached is inserted and advanced in the direction of the innominate vein, approximately 1 cm from the- junction of the clavicle and the lateral border of the sternocleidomastoid muscle (clavister- nomastoid angle, fig.
I) It is important to maintain a negative pressure while advancing the needle until a free- flow of blood is observed in the svrinre. When blood is observed a catheter is inserted and. threaded through the needle then the needle is removed. The catheter is connected to a 3 way stopcock which is connected to the intravenaus solution line. It is also important at the time that the needle is removed to put the patient in a semi- Fowlers position to decrease hematoma formation and allow the walls of the vein to contract around the inserted catheter. The complications of subclavian venepuncture and catheterization include pneumothorax hydrothorax, hemothorax, air embolism, hematoma, catheter embolism, thrombosis and sepsis etc. Fewer complications from a supraclavicular approach in comparison to a infraclavicular approach have been reported in various journals. In the supraclavicular subclavian vein catheterization, the above complications have not been major problems when attemptedunder careful supervision in our institution. |
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