Effect of Patient Position on Size and Location of the Subclavian Vein for Percutaneous Puncture

Abstract

Large-bore subclavian intravenous access is important during trauma resuscitation and to provide central access in the intensive care unit. Controversy exists as to the patient position that best facilitates the insertion of this line. Duplex scanning of the subclavian vein in different body positions may help define which provides the largest vein size and distance from the clavicle.

Comparative study of ultrasound guided subclavian venous cannulation versus conventional technique: Advantages and disadvantages

“…It depends on the choice of clinician only. The SCV is 3-4 cm long and lies posterior to the medial third of the clavicle; anterior to the anterior scalene, the brachial plexus, and the subclavian artery; and superior to the first rib 12 . The vein may stay patent even in hypovolemia because the vessel is surrounded by connective tissue, which is attached to adjacent structures 13 .…”

Supraclavicular Subclavian Vein Catheterization in Morbidly Obese

“…Slight trendelenburg position with head in either neutral position or slightly rotated towards the opposite side is used in this technique which provides the optimum filling of the subclavian vein. (4) This position needs minimal interruption to the already anaesthetized patient which saves time. In some patients, specially in females pushing the breast and tissues away from the infraclavicular area will expose the supraclavicular area.…”

Ultrasound-guided central venous access: which probe is preferred for viewing the subclavian vein using a supraclavicular approach?

“…Third, patients were enrolled in a convenience sample, which may have created a selection bias. Fourth, we did not require each patient be placed in the same position during assessment, such as uniform Trendelenburg positioning with a neutral head position, which may also have limited the sonologist to best visualize the SCV, though, hopefully, this was mitigated by producing a "realworld" situation that would favor the best performing probe [16,17]. Last, from our observational study, we cannot say whether probe preference translates into improved success or reduced complications because no data were collected on the success of vessel cannulation.…”