Modification of the right subclavian vein catheterization and its anatomic basis and techniques.
BACKGROUND
Several million subclavian-vein catheters are placed in patients each year to enable caregivers to administer chemotherapy, total parenteral nutrition, or long-term antibiotics or to manage preoperative fluids. Subclavian venipuncture requires the position of a deep vein to be identified with only surface landmarks. But the traditional right subclavian vein (RSV) catheterization (primitive procedures) is not the answer for all patients. The precise location of the vein is not known, and it is important to select the most appropriate method to achieve central venous access safely in any given patient. To modify the primitive procedures of the RSV catheterization for greater success and reduce the complications, anatomic studies and ultrasonography were conducted and clinical applications were validated.


METHODS
Anatomical observation and measurement of the RSV and its adjacent structures were performed on 20 adult cadavers according to modified procedures. The RSV catheterization of 2900 cases was carried out by the modified procedure, 500 of these cases were observed by ultrasonography after the operation.


RESULTS
The anatomical studies and clinical application showed that the insertion point differs from the bodily form of fatness or leptosome. The clinical data revealed that in the 2900 cases which were performed with the modified approach, the success rate was 98.90% (2868 cases), the failure rate was 1.10% (32 cases), and the complication rate is 0.79% (23 cases), and the catheterization time is (31.2 +/- 10.5) minutes. Five hundred and sixty cases of the RSV catheterization were carried out by the recommended insertion procedure; the results were compared with the modified approach and the traditional approach. The successful rate of the traditional approach was 73.0%, of which the complication rate was 6.1%; the two approaches were significantly different (successful rate: chi(2) = 626.642, P < 0.01; complication rate: chi(2) = 80.708, P< 0.01).


CONCLUSIONS
The modified RSV catheterization is characterized with a higher success rate and less complications, and the insertion procedure differs from the bodily form of fatness or leptosome.
Luo
Guang-hui
GH
Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China. luoyidao@vip.sina.com
Li
Wen-jian
WJ
Zhong
Shi-zhen
SZ
Li
Zhong-hua
ZH
Fang
Ji
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling; D002648:Child; D006801:Humans; D008875:Middle Aged; D013350:Subclavian Vein / Q000033:anatomy & histology
D000900:Anti-Bacterial Agents