Background Information: Central venous catheterization is a common procedure performed in the ICU for the purposes of drug administration and resuscitation. The subclavian vein is the more preferred access site given its fixed puncture location, ease for nursing access and low incidence of infections.1 Landmark guided catheterization has a widely variable success rate and has been shown to increase the risk of complications such as hematoma formation and pneumothoraxes.2,3 The use of real-time ultrasound guidance has thus led to more central lines being placed in the internal jugular and femoral lines, however there is substantial debate regarding its use in subclavian vein catheterization.4,5 The authors of this study sought to compare the efficacy and safety of static ultrasound-guided puncture with traditional anatomic landmark guided subclavian vein puncture.
The subclavian route is known to be the site for central line placement with the lowest risk of infection, but can also lead to many mechanical complications . The biggest risk of subclavian line placement is an iatrogenic pneumothorax. The use of ultrasound for subclavian line placement can greatly reduce this risk by watching the needle enter the vein. But does arm position matter for ultrasound guided subclavian central lines?...Read More