Misplacement of Subclavian Venous Catheters: Importance of Head Position and Choice of Puncture Site

Abstract

We have investigated the frequency of misplacement of subclavian catheters in 200 consecutive patients admitted to the Intensive Care Unit. The patients were allocated randomly to an attempt at infraclavicular cannulation of the right or left subclavian vein with the head turned either towards or away from the selected side, giving four groups. Catheterization was successful in 185 (92.5%) patients. Misplacement into the internal jugular vein occurred in 10 (5.4%) patients. No statistically significant difference (P less than 0.05) was demonstrated between the four groups.

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

“…Various techniques have been suggested to avoid aberrant location of a catheter [1-5]. The direction of the guidewire J-tip is associated with misplacement of a central venous catheter and higher rate of misplacement is reported when guidewire J-tip is directed cephalad [4,5].…”

Influence of orientations of guidewire tip on the placement of subclavian venous catheters

“…Boyd et al (6) reported the head position turned to the contralateral side improved the likelihood of successful central venous catheter placement. On the contrary, Sanchez et al (13) reported that the position of the head during infraclavicular subclavian vein cannulation did not have a clinically important effect on the likelihood of successful cannulation, or on misplacement of the catheter. Jesseph et al (7) used magnetic resonance image scanning and cadavers to examine the vein in the three positions and reported that the optimal position for vein puncture was the neutral position.…”

A Study on Ultrasound Assisted Cannulation of the Internal Jugular Vein in Comparison to the High Approach External Landmark Guided Technique

“…12 though uncommon complication of the cannulation and detected by immediate check chest X-ray or ultrasound guided placement. Central venous catheter tip placement at the junction of superior vena cava and right atrium is important for accurate central venous pressure measurement.…”