An anti-stray stylet for subclavian catheterization by the infraclavicular approach.
OBJECTIVE
Misplacement of subclavian vein catheters has been reported. We assessed the rate of misplacement of a subclavian vein catheter with and without a novel stylet.


METHODS
A prospective, randomized, controlled clinical trial was conducted between September 2001 and June 2003 in a university hospital. Two hundred sixteen adult patients were enrolled to receive subclavian vein catheterization under non-emergency conditions. Patients were randomly assigned to undergo right subclavian vein catheterization with the stylet (n = 109, stylet group) or without the stylet (n = 107, control group). The rate of subclavian vein catheter misplacement was determined and risk factors for failure and complications were analyzed.


RESULTS
There was no incidence of catheter misplacement in the stylet group, but this occurred in 12 patients in the control group in whom the catheter was misplaced into the ipsilateral internal jugular vein (0% versus 11.2%, P = 0.0003). In multivariate analyses, use of the stylet (odds ratio = 0.062, 95% confidence interval = 0.008 to 0.495, P = 0.009) and a close to average body mass index (odds ratio = 0.73, 95% confidence interval = 0.54 to 0.98, P = 0.038) were associated with low risks of complications and failure, respectively.


CONCLUSIONS
This stylet is useful for decreasing the incidence of misplacement of subclavian vein catheters. Body mass index is predictive of failed vein puncture.
Takeyama
Hiromitsu
H
First Department of Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan. takeyama@med.nagoya-cu.ac.jp
Taniguchi
Masaaki
M
Sawai
Hirozumi
H
Funahashi
Hitoshi
H
Hayakawa
Tetsushi
T
Tanaka
Moritsugu
M
Akamo
Yoshimi
Y
Sato
Mikinori
M
Yamamoto
Minoru
M
Suzuki
Sadao
S
Manabe
Tadao
T
D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D011446:Prospective Studies; D013348:Subclavian Artery; D017211:Treatment Failure