title: Simplifying subclavian vein cannulation using innovative landmarks: a radiologic, anatomic, and clinical study.
abstract: The objective of this study was to investigate novel and optimal landmarks for subclavian vein (SV) cannulation. We conducted the study in three phases: (a) Various possible markers for SV cannulation were evaluated by anatomic measurements in patients from intensive care unit and the course of SV was evaluated by radiologic means; (b) Results acquired by the two means were compared and adjusted, then innovative landmarks and a new approach for SV cannulation was proposed; (c) The efficacy of new approach for SV cannulation was compared with that of a traditional one by a prospective, randomized, controlled study. Point A (the junction of the lateral border of sternocleidomastoideus clavicular head and inferior border of clavicle), point B (a point on the lower border of clavicle just above the middle of the line joining the coracoid process and midline of the body), and point D (where SV crosses the inferior border of clavicle) were close in proximity. Points A and B could be considered as innovative landmarks for SV cannulation. Beginners using the new method had significantly higher success rate (86.9% vs. 70.2%, p = 0.008); the time consumed by new method was significant shorter than that by traditional one (5.9 vs. 10.4 min, p = 0.001). Points A and B could be considered as landmarks for identifying puncture site for SV cannulation. Beginners using innovative landmarks for SV cannulation could significantly reduce operation time and increase success rate.
authors.affiliation: Cardiovascular Division, Renhe Hospital, Three Gorge University, Yichang, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Hu
authors.forename: Mei
authors.initials: M
authors.lastname: Hu
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Dao Wen
authors.initials: DW
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D017115:Catheter Ablation; D002405:Catheterization, Central Venous / Q000379:methods*; D002968:Clavicle / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D004632:Emergency Medical Services / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009722:Nurse Practitioners; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D011859:Radiography; D013350:Subclavian Vein / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*