title: Ultrasound-guided supraclavicular central venous catheterization in patients with malignant hematologic diseases.
abstract: We present two cases of central venous catheterization (CVC) in which an ultrasound-guided in-plane approach was used. Case 1 was a 60-year-old man with acute myelogenous leukemia in whom a right supraclavicular CVC was performed. He had pancytopenia (leukocytes 2,000/μL; erythrocytes 350 × 10(4)/μL; platelets 5.6 × 10(4)/μL), and abnormal coagulability (prothrombin time-international normalized ratio 1.35). A linear array transducer was positioned cephalad to the right clavicle and rotated 30° clockwise. The 21-gauge needle was manipulated from outside of the transducer. A CV catheter (CV legaforce EX(®); Terumo Co., Japan) was placed and stitched near the right clavicle. The patient felt no discomfort caused by the catheter. Case 2 was a 64-year-old women with malignant lymphoma whose right internal jugular vein was surrounded by abnormally enlarged lymph nodes. CVC was performed by the in-plane supraclavicular approach, avoiding puncture of the lymph node. This novel CVC technique is useful to minimize the risk of complications and patient discomfort by indwelling catheter.
authors.affiliation: Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. yamauchi@sapmed.ac.jp
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamauchi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Sasaki
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Yoshida
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Niiya
authors.forename: Eri
authors.initials: E
authors.lastname: Mizuno
authors.forename: Eichi
authors.initials: E
authors.lastname: Narimatsu
authors.forename: Michiaki
authors.initials: M
authors.lastname: Yamakage
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods*; D002968:Clavicle / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000000981:diagnostic imaging* / Q000601:surgery*; D008223:Lymphoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018084:Ultrasonography, Interventional / Q000379:methods*