title: Ultrasound-guided subclavian vein cannulation using a micro-convex ultrasound probe.
abstract: BACKGROUND
  The subclavian vein is the preferred site for central venous catheter placement due to infection risk and patient comfort. Ultrasound guidance is useful in cannulation of other veins, but for the subclavian vein, current ultrasound-guided techniques using high-frequency linear array probes are generally limited to axillary vein cannulation.
  
  
  METHODS
  We report a series of patients who underwent clinically indicated subclavian venous catheter placement using a micro-convex pediatric probe for real-time guidance in the vein's longitudinal axis. We identified rates of successful placement and complications by chart review.
  
  
  RESULTS
  Twenty-four catheters were placed using the micro-convex pediatric probe with confirmation of placement of the needle medial to the lateral border of the first rib. Sixteen of the catheters were placed by trainee physicians. In 23 patients, the catheter was placed without complication (hematoma, pneumothorax, infection). In one patient, the vein could not be safely cannulated without risk of arterial puncture, so an alternative site was selected.
  
  
  CONCLUSIONS
  Infraclavicular subclavian vein cannulation using real-time ultrasound with a micro-convex pediatric probe appears to be a safe and effective method of placing subclavian vascular catheters. This technique merits further study to confirm safety and efficacy.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine and Intermountain Medical Center.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lanspa
authors.forename: James
authors.initials: J
authors.lastname: Fair
authors.forename: Eliotte L
authors.initials: EL
authors.lastname: Hirshberg
authors.forename: Colin K
authors.initials: CK
authors.lastname: Grissom
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Brown
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods*; D015331:Cohort Studies; D006801:Humans; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*