Supraclavicular Subclavian Venepuncture and Catheterisation

Yoffa, D. E.

doi:10.1016/s0140-6736(65)90519-2

Cited by 170 publications

(93 citation statements)

References 10 publications

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“…(13) In 1965 Yoffa presented the first report of supraclavicular approach to subclavian vein cannulation. (17) Garcia et.al later fine tuned the technique to include a more shallow entry and passage of the needle. They noted that in cadaveric dissections it was simpler to aim at the junction of the subclavian vein and the internal jugular vein.…”

Section: Discussionmentioning

confidence: 99%

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Supraclavicular Subclavian Vein Catheterization in Morbidly Obese

Pathiraja

Sharpe

Woojner

et al. 2009

Sri Lankan J Anaesthesiol

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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.

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Section: Discussionmentioning

confidence: 99%

“…A 22 gauge long seeker needle was inserted bisecting the sterno cleidomastoidclavicular angle with 10 degrees above the horizontal plane, which was similar to the technique describe by Yoffa. (17) After each pass the barrel of the syringe was elevated a few degrees. Each attempt was made slowly with gentle aspiration applied continuously.…”

Section: Methodsmentioning

confidence: 99%

Supraclavicular Subclavian Vein Catheterization in Morbidly Obese

Pathiraja

Sharpe

Woojner

et al. 2009

Sri Lankan J Anaesthesiol

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“…Complication rates range between 0.1-10% (Seneff, 1991). Acute complications, with an incidence of 7.2%, are incurred during catheter insertion and are basically iatrogenic (Davidson et al, 1963;Yarom, 1964;Yoffa, 1965;Borja, 1972;Ryan et al, 1974;Voegele, 1976;Herbst, 1978;Goutail-Flaud et al, 1991;Yerdel et al, 1991a,b;Ballard et al, 1992).…”

Section: Introductionmentioning

confidence: 99%

Brachiocephalic veins: An overlooked approach for central venous catheterization

2002

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Central venous access is important in both assessment and treatment of the patient. In modern clinical practice, a percutaneous approach is preferred. The well-established subclavian and internal jugular vein catheterization techniques, however, still carry the risk of major acute complications. In this article we describe a trial study of a percutaneous brachiocephalic vein catheterization technique conducted on a total of 74 cadavers undergoing autopsy. Relying on constant and easily recognizable anatomical landmarks, we performed a total of 128 catheterizations of the right and left brachiocephalic veins. The success of catheterization was ascertained by regional dissection. Our results show very high reproducibility with a success rate of about 97% on the first attempt of catheterization on both right and left sides. Equally important, collateral injury of neighboring structures was consistently absent. We propose the introduction of this rather overlooked approach into clinical practice.

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“…Supported by our previous experience, 9,13,14 our hypothesis was that routine fluoroscopic guidance could be avoided by using the supraclavicular access. Additionally both the high success and low complication rates, [13][14][15][16][17] as well as the coaxial lie of the catheter (Figure 1) in the vessel encour- aged us to perform this prospective study to evaluate the supraclavicular approach for placement of Hickman catheters without fluoroscopic or sonographic guidance.…”

mentioning

confidence: 99%

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

Apsner

Schulenburg

Sunder‐Plassmann

et al. 1998

Bone Marrow Transplant

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Summary:The purpose of this study was to evaluate the efficacy and safety in placement of Hickman catheters via the supraclavicular route without fluoroscopic guidance. We studied 81 consecutive percutaneous placements of dual lumen Hickman catheters via the supraclavicular route without the use of fluoroscopic guidance. Success rates, technical problems, complications, infections and reasons for explantation were recorded prospectively. Seventy-nine punctures were successful (97.5%). One pneumothorax (1.2%) and three accidental arterial punctures (3.7%) occurred. Difficulties in introducing the catheter through the peel away sheath or misplacement were not observed. The catheters remained in place for a total of 7657 days (mean 94.5, range 3-392 days). Sixteen blood cultures were positive (2.1/1000 catheter days). Five catheters (6.1%) were lost because of mechanical complications. Forty-two lines (52%) were removed electively, 23 (28.4%) because of suspected infection, and two (2.5%) because of tunnel infection. Nine patients died with a functioning catheter. We conclude that the supraclavicular approach to the subclavian vein is safe and efficient for introduction of Hickman catheters. Using this access, routine fluoroscopic or sonographic guidance is not required for proper placement. Implantation of the lines in an intensive care unit did not lead to higher infection rates than those reported in the literature. Keywords: Hickman; supraclavicular access; fluoroscopic guidance; infection; bone marrow transplantation Central venous access for antineoplastic treatment, supportive therapy and parenteral nutrition is required in most patients scheduled for bone marrow transplantation (BMT). In many centers a Hickman catheter is routinely inserted before BMT. [1][2][3] Usually the infraclavicular route to the subclavian vein is chosen for percutaneous implantation of the line. [4][5][6] Pneumothorax, arterial puncture and chylothorax are well known complications of this approach. 7 number of problems occur during placement of permanent catheters from the infraclavicular site: failure to pass the gap between the first rib and the clavicle, kinking of the guide wire and the introducer sheath and misplacement of the line into adjacent vessels such as the contralateral subclavian vein or both internal jugular veins. 6-10 For these reasons implantation is usually performed under fluoroscopic guidance in the operation theatre or angiogram suite, 5,6 which is expensive and causes exposure of the patient to radiation and potential nephrotoxic contrast media. Secondary migration, compression (the pinch off sign) and fragmentation of the catheter are other adverse events related to the infraclavicular approach. 6,11,12 The obvious disadvantages of the infraclavicular route prompted us to evaluate a 'new' approach for placement of Hickman catheters in patients scheduled for BMT. Supported by our previous experience, 9,13,14 our hypothesis was that routine fluoroscopic guidance could be avoided by using the supraclavicular ac...

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Supraclavicular Subclavian Venepuncture and Catheterisation

Cited by 170 publications

References 10 publications

Supraclavicular Subclavian Vein Catheterization in Morbidly Obese

Supraclavicular Subclavian Vein Catheterization in Morbidly Obese

Brachiocephalic veins: An overlooked approach for central venous catheterization

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

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