Modification of the technique for subclavian-vein catheterization.
BACKGROUND
In invasive monitoring, subclavian-vein puncture is a routine procedure indicated for central vein cathe-terization. It is indicated in patients according to hospital stay, including the administration of drugs and the treatment of chronic and cardiac disease. The techniques described to date include infraclavicular percutaneous puncture; others place catheters using angiographic methods, and the use of magnetic resonance imaging and ultrasound has also been reported. Studies have been done in cadavers to get a better understanding of the procedure since the relationship between vascular elements and surrounding tissues are obtained. The usual technique is with the patient in Trendelenburg position, with the arm in adduction, the placement of an interscapular roll, and the head turned away from the puncture site.


OBJECTIVE
The aim of this study was to demonstrate less frequent technical failures and complications using a modification of the usual technique. We propose catheterization of the right subclavian vein with the patient in decubitus, without an interescapular roll, with the arm in abduction and using the distal third of the clavicle and the suprasternal notch as anatomical references.


RESULTS
Two technical puncture failures and three complications occurred in a total of 42 patients with a statistically significant difference (p = 0.0410) in frequency (11.9%) from that reported with the traditional technique (21.8%).


CONCLUSIONS
Greater efficacy with the technique modified by the authors was confirmed. Anatomical cadaver dissections showed a greater space between the right subclavian vein and the clavicle.
Cantú-Martínez
Alonso
A
Servicio de Anestesiología, Hospital Universitario Dr. José E. González, Escuela de Medicina, UANL.
de-la-Garza-Castro
Oscar
O
Espinosa-Galindo
Ana María
AM
Cárdenas-Estrada
Eloy
E
de-la-Garza-Pineda
Oscar
O
Palacios-Ríos
Dionisio
D
Guzmán-López
Santos
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013350:Subclavian Vein; D055815:Young Adult