Head position for facilitating the superior vena caval placement of catheters during right subclavian approach in children.
OBJECTIVE
To evaluate the effect of head position as a method to facilitate the superior vena caval placement of catheters during right subclavian catheterization in children.


METHODS
Prospective, randomized, clinical trial.


METHODS
Department of anesthesiology, university hospital.


METHODS
One hundred sixty-eight pediatric patients, aged <8 yrs, undergoing simple cardiac surgery or pediatric general surgery.


METHODS
At operation, the patients were assigned by the stratified randomization for age to one of the four groups (n = 42 each): when the patients turned their heads away from the puncture side, this was away-turning group; when turned toward the puncture side, toward-turning group; when lateral-flexed (tilted) away from the puncture side, away-lateral-flexion group; and when lateral-flexed toward the puncture side, toward-lateral-flexion group. Each group was divided into two subgroups depending on the age: infant (n = 24 each) and young children (>12 months; n = 18 each).


RESULTS
Right infraclavicular subclavian catheterization, using the Seldinger technique, was attempted. After catheterization, a simple chest radiograph was used to identify the location of catheter tip. There was no difference in age and body weight between the groups. Only in infants was the successful placement rate of toward-lateral-flexion group (92%) higher than that of the other three groups (54% [away-lateral-flexion], 63% [away-turning], or 54% [toward-turning]), and there was no difference among the others.


CONCLUSIONS
In infants, tilting the head toward the catheterization side can reduce the incidence of catheter malposition during the right subclavian approach.
Jung
Chul-Woo
CW
Department of Anesthesiology and Clinical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Bahk
Jae-Hyon
JH
Kim
Myung-Won
MW
Lee
Kook-Hyun
KH
Ko
Hong
H
D000367:Age Factors; D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006257:Head; D006801:Humans; D007223:Infant; D008297:Male; D011187:Posture; D011446:Prospective Studies; D013350:Subclavian Vein; D014683:Vena Cava, Superior