title: Limiting vein puncture to three needle passes in subclavian vein catheterization by the infraclavicular approach.
abstract: OBJECTIVE
  With central venous catheterization, each additional vein puncture raises the risk of complications. We assessed the rate of failure and complications using a limiting rule whereby the number of needle passes for subclavian vein catheterization was restricted to three.
  
  
  METHODS
  A prospective clinical trial was conducted between September 2001 and December 2003 in a university hospital surgical department. Two hundred and thirty-two adult patients were enrolled to undergo subclavian vein catheterization under non-emergency conditions. The patients were subjected to right subclavian vein catheterization by the infraclavicular approach. Vein puncture failure was defined as such if venipuncture was not accomplished after three attempts. Any arterial puncture was judged to be a failure immediately.
  
  
  RESULTS
  Vein puncture failure occurred in nine patients (3.9%), and included two arterial punctures (0.9%). No other complications, such as pneumothorax, hemothorax, plexus lesion, mediastinal hematoma or bleeding, or air embolism, were observed. In multivariate analyses, a close to average body mass index (weight in kilograms divided by the square of the height in meters, odds ratio 0.74; 95% confidence interval 0.56-0.97; P = 0.028) was associated with a low risk of failure.
  
  
  CONCLUSIONS
  Limiting the number of needle passes to three may therefore prevent mechanical complications. A low body mass index was predictive of vein puncture failure.
authors.affiliation: Department of Gastroenterological Surgery, Nagoya City University, Graduate School of Medical Sciences, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Takeyama
authors.forename: Masaaki
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Hirozumi
authors.initials: H
authors.lastname: Sawai
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Funahashi
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Akamo
authors.forename: Sadao
authors.initials: S
authors.lastname: Suzuki
authors.forename: Tadao
authors.initials: T
authors.lastname: Manabe
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods; D002406:Catheterization, Peripheral / Q000295:instrumentation* / Q000379:methods; D002968:Clavicle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011677:Punctures; D013350:Subclavian Vein; D017211:Treatment Failure; D016896:Treatment Outcome