Supraclavicular Subclavian Vein Catheterization in Morbidly Obese

Abstract

Background:Obesity is one reason which will make central venous catheterization a difficult procedure. Ultrasound will help in locating the veins but in some patients because of short neck, internal jugular approach will be technically difficult. Supraclavicular approach to subclavian cannulation has been described as being less dependent on anatomical land marks and associated with comparatively less complications even in inexperienced hands. Literature does not show the effectiveness of this method in morbidly obese patients. Our aim of this study was to investigate the rates of success and complications of supraclavicular subclavian central venous catheterization in the morbidly obese. Methods:From amongst the morbidly obese patients who presented for FOBI gastric pouch bypass surgery, supraclavicular approach to subclavian venous cannulation was attempted by an anaesthetic registrar who was relatively new to this technique. Closed questionaire was used to gather data such as age, gender, weight, height, BMI, attempts with seeker needle and proper needle. Immediate and late complications were noted till catheter removal. Results:Catheterization was attempted in 48 patients with mean weight 131.29+/-29.89kg and mean BMI of 47.60+/-9.80. Overall success rate was 97.9% (47 out of 48 patients) with average attempts 1.44 (68 in 47 successful cannulations) of seeker needle and with average attempts 1.40 (66 in 47 successful cannulations) of proper needle. There was 01 pneumothorax, 01 catheter malposition and 01 catheter related infection. Conclusion:Supraclavicular approach is a reliable way of obtaining central venous access with less complications in obese, even in less experienced hand.

Endocavitary versus linear array high-frequency probe in ultrasound-guided supraclavicular subclavian vein central access

“…The supraclavicular (SC) approach is particularly advantageous because of the short distance from skin to vein and the straighter path to the superior vena cava. [ 2 3 ]…”