title: The effect of full expiration on the position and size of the subclavian vein in spontaneously breathing adults.
abstract: BACKGROUND
  If full expiration during subclavian venous cannulation increases the distance between the subclavian vein (SCV) and the pleura or increases the diameter of the vein, it might decrease the incidence of pneumothorax and/or increase the success rate of venous cannulation. In this study, we evaluated the effect of full expiration on the distance from the SCV to the pleura and on the crosssectional area (CSA) of the SCV in spontaneously breathing adults.
  
  
  METHODS
  The distance from the inferior border of the right SCV and the pleura (SCVinf-Pleura distance), the distance from the center of the vein to the pleura (SCVcen-Pleura distance), and the CSA of the vein were measured using ultrasound at the end of inspiration and at the end of full expiration in 20 adults placed in the horizontal position. The subjects were then placed in 15° Trendelenburg tilt, and the distances and the CSA were measured again.
  
  
  RESULTS
  The SCVcen-Pleura distances were changed minimally in the horizontal position (0.005 cm, 95% confidence interval [CI] -0.04 to 0.05) and in the Trendelenburg position (0.02 cm, 95% CI -0.005 to 0.05). The SCVinfPleura distances decreased at the end of full expiration in the horizontal position, but the change was only 0.07 cm (95% CI 0.03-0.11; P = 0.003). In the Trendelenburg position, those distances remained unchanged (0.02 cm, 95% CI -0.01 to 0.06). Compared with endinspiration, the SCV CSA after full expiration increased by at least 14% in both the horizontal position and the Trendelenburg position.
  
  
  CONCLUSIONS
  The distance from the SCV to the pleura did not change after full expiration. However, this simple technique can still be considered during placement of subclavian catheters in spontaneously breathing patients, because it significantly enlarges the CSA of the SCV.
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 DaeHakRo, JongRoGu, Seoul, 110-744, Korea. kimjintae73@dreamwiz.com
authors: Kyung-Jee
authors: KJ
authors: Lim
authors: Jung-Man
authors: JM
authors: Lee
authors: Hyo-Jin
authors: HJ
authors: Byon
authors: Hee-Soo
authors: HS
authors: Kim
authors: Chong-Sung
authors: CS
authors: Kim
authors: Soo-Kyung
authors: SK
authors: Lee
authors: Jin-Tae
authors: JT
authors: Kim
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods; D045853:Exhalation / Q000502:physiology*; D006801:Humans; D008297:Male; D015656:Respiratory Mechanics / Q000502:physiology*; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult