A novel supraclavicular approach to the right subclavian vein based on three-dimensional computed tomography.
BACKGROUND
We used three-dimensional (3-D) computed tomography to develop a novel supraclavicular approach to the subclavian vein that minimizes the distance from insertion site to the vein.


METHODS
Forty-five adult patients with normal body build were retrospectively included in the 3-D computed tomography investigation. Assuming that the clavisternomastoid angle was the skin entry point, and that the subclavian vein on the first rib was a target, the optimal angle of approach was measured on the simulated 3-D images. A 3-D video was developed from these images to explain the approach. In a pilot study, we prospectively tested this approach in 60 adult patients with normal body build requiring central venous catheterization. The number of attempts, success rate, and complications were noted.


RESULTS
The optimal angle of approach was 10.6 degrees +/- 5.3 degrees medially and 35.4 degrees +/- 12.5 degrees posteriorly from the skin entry point. The estimated depth of the subclavian vein was 13.7 +/- 3.1 mm. During the pilot study, the first trial with a finder needle was successful in 87% of patients and the overall success rate of catheterizations was 100% without complications.


CONCLUSIONS
The proposed supraclavicular approach to the subclavian vein is a simple method of central venous catheterization. The pilot study suggests the method is reasonably safe. The video explaining the approach graphically is available in the supplementary material.
Jung
Chul-Woo
CW
Department of Anesthesiology, Seoul National University College of Medicine, Yongon-Dong, Jongno-Gu, Seoul, Korea.
Seo
Jeong-Hwa
JH
Lee
Whal
W
Bahk
Jae-Hyon
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods*; D002968:Clavicle / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*