Hazards of Subclavian Vein Cannulation for Central Venous Pressure Monitoring

Schapira, M

doi:10.1001/jama.1967.03130050061024

Cited by 48 publications

(9 citation statements)

References 5 publications

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“…Three previous cases have been reported (Smith et al, 1965;Matz, 1965;Schapira & Stern, 1967). We report a fourth case and review the complications of subclavian vein cannulation.…”

mentioning

confidence: 68%

“…Published reports are sharply polarized between those who consider the subclavian cannula to be the most satisfactory route for central venous monitoring (Longesbeam et al, 1965;Yoffa, 1965;Defalgue, 1968;Craig et al, 1968) and those who feel that the serious complications warrant the abandonment of the technique (Smith et al, 1965;Matz, 1965;Schapira & Stern, 1967). A compromise is probably the correct view.…”

Section: Discussionmentioning

confidence: 99%

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Acute haemothorax—a hazard of subclavian vein cannulation

Thurlow

Chilvers

1972

Postgraduate Medical Journal

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DIRECT infusion of fluid into the pleural cavity via a cannula is a dangerous complication of subclavian venepuncture. Three previous cases have been reported (Smith et al., 1965;Matz, 1965;Schapira & Stern, 1967 On arrival in the operating theatre he had a blood pressure of 80/40 mmHg and the subclavian cannula recorded a pressure of + 2 cm H20 with good respiratory fluctuation. Laparotomy revealed pyloric stenosis with a pre-pyloric ulcer 5 cm in diameter. Control of the haemorrhage was achieved and a Polya partial gastrectomy done.During the anaesthetic it was noticed that respiratory movement was reduced on the left side of the chest. Auscultation revealed reduced air entry on that side. The endotracheal tube was withdrawn to its limit in case of right bronchial intubation. Endotracheal suction and hyperventilation was carried out with no improvement. As the patient's colour was good and as there had been no deterioration during the anaesthetic it was decided to complete the operation and assess the chest fully afterwards. During the operation a further 8 units of blood were given into the saphenous vein cannulae. The left subclavian vein cannula was used for monitoring venous pressure.Throughout it showed a good respiratory swing and recorded pressures varying from 0 to + 6 cm H20.After operation, a chest X-ray taken on the table showed a large left pleural effusion (Fig. 1). A diagnostic tap showed this to be blood. A size 20 Argyle chest drain was inserted into the second intercostal space in the mid clavicular line of the front of the left chest. Four litres of blood were removed from the chest. The chest movements improved and air entry became normal.Fifteen millilitres of 40Y Hypaque were injected down the subclavian cannula and a further chest X-ray taken (Fig. 2). This showed the cannula lying freely in the pleural cavity with overspill of the dye. The cannula was withdrawn and a compression dressing put on the neck.Flo. 1. Chest X-ray showing haemothorax before aspiration.

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“…Three previous cases have been reported (Smith et al, 1965;Matz, 1965;Schapira & Stern, 1967). We report a fourth case and review the complications of subclavian vein cannulation.…”

mentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Acute haemothorax—a hazard of subclavian vein cannulation

Thurlow

Chilvers

1972

Postgraduate Medical Journal

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“…The risk of accident with the subclavian route is increased in patients with neck and shoulder generative joint disease (16), obesity, cachexia and chest wall deformities (17), and scoliosis (18). Obviously, the procedure is often risky in the uncooperative patient, and always so when performed by the unsupervised inexperienced physician.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, when subclavian venipuncture is unsuccessful, such patients should never receive contralateral attempts before radiographic exclusion of ipsilateral pneumothorax has been first obtained. Fatal bilateral pneumothoraces have occurred (17) and persistent air leaks and bronchopleural fistulae have been reported (Table v).…”

Section: Discussionmentioning

confidence: 99%

Choice of route for central venous cannulation: Subclavian or internal jugular vein? A prospective randomized study

Kaiser

Koornick

Smith

et al. 1981

Journal of Surgical Oncology

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The clinical need for central venous cannulation has been well established. The usual route for catheter placement is by either the subclavian or internal jugular vein. No randomized, prospective evaluation has been yet conducted to determine which of these approaches, if either, is better with respect to reliability, placement, and frequency of nonseptic complications. One hundred consecutive patients requiring elective central venous cannulation were randomized to either the subclavian or internal jugular route. Successful venipuncture and catheter passage were significantly more common with the subclavian route, and in the absence of special clinical situations, it appears to be the route of choice.

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“…5 Though Wilson and Associates popularised subclavian vein catheterisation, Shapira et al recommended its discontinuation due to serious complications of pneumothorax and haemothorax. 6 Percutaneous right internal jugular vein cannulation can be made by landmark-or ultrasound-guided technique. The use of ultrasound and Doppler to assist internal jugular vein cannulation was reported as early as 1984.…”

Section: Introductionmentioning

confidence: 99%