title: Evaluating the detailed position of the subclavian artery to avoid inadvertent subclavian artery puncture during right internal jugular vein catheterization.
abstract: OBJECTIVE
  Central venous catheter placement is useful but is associated with complications. Inadvertent subclavian artery (SCA) puncture is a rare complication associated with internal jugular vein (IJV) catheterization. We determined the position of the SCA by ultrasonography, and propose a needle-insertion position for avoiding inadvertent SCA puncture.
  
  
  METHODS
  We positioned an ultrasound probe at an angle of 60° to the skin to mimic a puncture needle halfway between the clavicle and the angle of the mandible (center) and moved the probe parallel to the right IJV (RIJV) toward the clavicle until locating the SCA. We measured the distance from the clavicle to the probe 60 and from the probe to the SCA (P60-SCA) where the SCA was visible by ultrasonography.
  
  
  RESULTS
  For 50 volunteers with a mean age of 27.3 years, the center position was, on average, 67 mm from the clavicle. The image of the SCA appeared within 65 mm of the clavicle. P60-SCA differed significantly between men and women (p = 0.0058). For 45 volunteers, P60-SCA was <25 mm with the probe 65 mm from the clavicle on the skin. RIJVP-SCA averaged 4.4 mm. Only P60-SCA correlated well with BMI for men (r = 0.732, p = 0.0068).
  
  
  CONCLUSIONS
  Puncturing the RIJV away from the center should avoid SCA puncture; puncturing it while approaching the clavicle is more dangerous. The exact location of the SCA varies from person to person; thus, confirming SCA position by ultrasonography is recommended every time before puncturing.
authors.affiliation: Department of Anesthesia, Japan Community Health Care Organization, Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Imai
authors.affiliation: Department of Anesthesia, Japan Community Health Care Organization, Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan. ken5ji5ka5ya5shi5ma@nifty.com.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kayashima
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000379:methods*; D002968:Clavicle / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D009339:Needles; D013348:Subclavian Artery / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult
keywords: Central venous catheter; Jugular veins; Subclavian artery; Ultrasonography