Influence of arm position during infraclavicular subclavian vein catheterization in coronary artery bypass graft surgery

Tarbiat, Masoud; Davoudi, Maryam; Salimbahrami, Sayed Ahmadreza

doi:10.15171/jcvtr.2018.33

Cited by 7 publications

(10 citation statements)

References 17 publications

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“…It was defined as a catheter tip located in the IJV or contralateral SV (9). Since a sharp angulation exists between the right-sided SV and the right IJV, most catheter tips are positioned in the right IJV (2, 14). Catheter tip malposition may cause local venous thrombosis, elevated intracranial pressure, infection, retrograde perfusion of the intracranial vein, and inaccurate central venous pressure reading.…”

Section: Discussionmentioning

confidence: 99%

“…Cannulation of a central vein is a common procedure in cardiac surgery for monitoring central venous pressure, cardiopulmonary resuscitation, insertion of a transvenous pacemaker, difficult peripheral catheterization, and rapid fluid resuscitation (1, 2). Nowadays, percutaneous infraclavicular subclavian vein (SV) cannulation is a well-known invasive procedure performed by anesthesiologists in cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Cannulation Point on Infraclavicular Subclavian Vein Catheterization: A Clinical Trial

2019

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BackgroundChoosing a proper approach to subclavian vein cannulation is a challenge for physicians. However, percutaneous infraclavicular subclavian vein cannulation is now an acceptable technique.ObjectivesThe present study was performed to compare the success rate and complications of subclavian vein cannulation using the midpoint technique and the lateral technique.MethodsIn this prospective randomized clinical trial, we randomly assigned 440 patients undergoing subclavian vein cannulation to either midpoint approach or lateral approach groups from April 2018 to February 2019. The complications and success rates of catheterization were compared between the two approaches. The data were analyzed using SPSS software (version 20).ResultsUnlike the first attempt of catheterization, the success rate was significantly higher in the midpoint technique (75 %) than in lateral technique (39%) in the second attempt (P = 0.003). The overall success rates were 96.8% and 88.6% in the midpoint approach and lateral approach, respectively. A significant difference was observed between the two techniques in the overall success rate (P = 0.001). Inadvertent subclavian artery puncture occurred in 26 (5.9%) patients including 3 (1.4%) patients in the midpoint technique and 23 (10.5%) patients in the lateral technique. In 19 (4.3%) patients, malposition of the catheter tip occurred, including 14 (6.4%) in the midpoint approach and 5 (2.3%) in the lateral approach. There was a significant difference between the two approaches in malposition and subclavian artery puncture (P = 0.035 and P = 0.0001, respectively). There were no significant differences between the two techniques in other complications.ConclusionsThis investigation showed that the midpoint approach was more appropriate than the lateral approach for infraclavicular subclavian vein catheterization with landmark-based techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of Cannulation Point on Infraclavicular Subclavian Vein Catheterization: A Clinical Trial

2019

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“…This prospective comparative study, after approval from ethical committee, was conducted at Sheikh Zayed Medical College Rahim Yar Khan Pakistan, in a period from 1 st July 2017 to 30 th June 2018, in Critical care and Coronary care units. By keeping confidence level 95% and power of 80%, on the basis of a previous study 12 , sample size of 95 patients was calculated, which was rounded of to 100. Patients were taken in the study through convenient sampling, aged between 15 years to 85 years.…”

Section: Methodsmentioning

confidence: 99%

“…Subclavian venous catheterization can be performed via supra or infraclavicular routes, amongst which infraclavicular route is more popular. 9,12 On the DOI: 10.29309/TPMJ/2020.27. 10.4483 other hand, subclavian vein is the most popular one as compared to internal jugular vein for catheterization, because of its association with lesser infectious complications [13][14][15] & better tolerance by critical care patients.…”

Section: Introductionmentioning

confidence: 99%

“…4 Similarly another study conducted by Tarbiat M. et al in Iran shows results which confirms success rate of neutral arm position vs. ipsilateral abducted arm position for infraclavicular subclavian VC insertion 96.2 % vs 84.4% respectively. 12 Another study conducted by Fortune JB et al in US, has compared Trendelenburg position, retracted shoulder position and head turned position for subclavian VC insertion. Their results show superiority of Trendelenburg position over other two positions.…”

Section: Introductionmentioning

confidence: 99%

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A study to compare effects of shoulder position on infraclavicular central venous catheterization in critically ill patients.

Sadaf¹,

Bashir

2020

TPMJ

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Objectives: Aim of this study was to compare the effects of two different shoulder positions on infraclavicular subclavian venous catheterization in critically ill patients. Study Design: Prospective Comparative study. Setting: Sheikh Zayed Medical College Rahim Yar Khan Pakistan. Period: 1st July 2017 to 30th June 2018. Material & Methods: Enrolling 100 patients thru convenient sampling, divided into two groups, Group A & Group B, 50 in each group. In group A patients were put in supine position, with head turned to contra lateral side and caudal pull was applied on ipsilateral shoulder. While in group B patients were lying supine, head turned to contra lateral side and shoulders were retracted by placing a small pillow vertically under the chest between the scapulae. In both groups, subclavian vein was approached through infra clavicular route. Number of attempts of venous punctures (1st attempt / 2nd attempt), total time spent on procedure (from 1st skin puncture to CVC insertion), complications (arterial puncture, pneumothorax, hydrothorax, malpositioning), any hemodynamic irregularity (ECG changes), radiographic findings to confirm successful CVC insertion was recorded. Results: Number of successful subclavian venous catheterizations was same in both groups (94% vs. 94%) with no significant difference (p= 1.000). 1st attempt success was more in group A as compared to group B, though statistically this was not significant (p= 0.275). Total time spent on CVC insertion (from 1st skin puncture to catheter insertion) was less than 05 mints in 84% patient in group A and 82% in group B. While more than 05 mints were spent on 16% vs. 18% patients in group A vs. B. This was also not statistically significant (p=0.790). In group A 2/50 (4%) while in group B 1/50 (2%) cases were recorded as malpositioning on post-CVC radiograph. Other complications were not encountered in either group. Conclusion: Lowered shoulder and retracted shoulder positions are equally effective for SVC insertion in terms of success, 1st attempt success, total time spent and number of complications.

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Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation

Klaiber

Probst

Hackbusch

et al. 2021

Langenbecks Arch Surg

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Background There is still no reference standard for the implantation of totally implantable venous access ports (TIVAPs). A recently published multicentre randomised controlled trial (RCT) revealed a significantly greater risk of pneumothorax after closed cannulation than after an open strategy. The aim of this meta-analysis was to provide an update of the available evidence for the safety and effectiveness of primary open versus closed cannulation strategy. Methods RCTs comparing outcomes of open cut-down of the cephalic vein and closed cannulation of the subclavian vein were sought systematically in MEDLINE, Web of Science and CENTRAL. The primary outcome was the occurrence of pneumothorax. A beta-binominal model was applied to combine the respective outcomes, and results are presented as odds ratios (OR) with 95% confidence interval (CI). Results Six RCTs with a total of 1831 patients were included in final analysis. Meta-analysis showed statistically significant superiority of the open cut-down technique regarding pneumothorax (OR 0.308, 95% CI 0.122 to 0.776), but a statistically significant higher failure of the primary technique for the open cut-down technique than for closed cannulation (OR 2.364, 95% CI 1.051 to 5.315). There were no significant differences between the two procedures regarding other morbidity endpoints. Conclusion This meta-analysis shows a general superiority of open cut-down of the cephalic vein over closed cannulation of the subclavian vein regarding the occurrence of pneumothorax. Open cut-down should be the first-line approach for TIVAP implantation. Closed cannulation should be performed with ultrasound as second-line procedure if the open technique fails. Systematic review registration PROSPERO CRD42013005180

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Influence of arm position during infraclavicular subclavian vein catheterization in coronary artery bypass graft surgery

Cited by 7 publications

References 17 publications

Influence of Cannulation Point on Infraclavicular Subclavian Vein Catheterization: A Clinical Trial

Influence of Cannulation Point on Infraclavicular Subclavian Vein Catheterization: A Clinical Trial

A study to compare effects of shoulder position on infraclavicular central venous catheterization in critically ill patients.

Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation

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