Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach.
BACKGROUND
Infraclavicular approach of the subclavian veins is commonly used for central venous access. However, aberrant catheter tip locations are frequently quoted for this approach. It was hypothesized that with the shoulder pulled downwards, the angle between the internal jugular and subclavian veins may increase, directing subclavian catheters into the internal jugular vein. This prospective study assessed the influence of the shoulder position on proper placement of right infraclavicular subclavian catheters.


METHODS
Patients who required subclavian central venous catheterization for major neurosurgical and thoracic procedures were randomly divided into two groups: neutral (n=180) vs lowered (n=181) shoulder position. The right shoulder was placed and maintained in the neutral or lowered position during venipuncture and guidewire insertion. Postoperative chest radiographs were obtained to identify the location of catheter tips.


RESULTS
There were no differences in gender, age, body weight, and height between the two groups. There were five failures in the neutral position [5/180 (2.8%)] and eight failures in the lowered shoulder position [8/181 (4.0%)] (P=NS). The occurrence of immediate complications such as pneumothorax or arterial puncture was not different. Aberrant placement of the catheter tips was more frequent in the lowered shoulder position [2/173 (1.2%) vs 14/173 (8.1%)] (P<0.01).


CONCLUSIONS
The neutral shoulder position minimizes the number of needle passes and the incidence of catheter misplacement during the infraclavicular approach of the right subclavian vein catheterization.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehang-no, Jongno-gu, Seoul 110-744, Republic of Korea.
M
M
Kang
H-G
HG
Ryu
I-S
IS
Son
J-H
JH
Bahk
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016121:Brachiocephalic Veins; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005547:Foreign Bodies / Q000209:etiology; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011446:Prospective Studies; D012782:Shoulder; D013350:Subclavian Vein; D055815:Young Adult