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Anesth Analg 2018 Jul;127(1):83-89

From the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.

Background: We investigated whether visual augmentation (3D, real-time, color visualization) of a procedural simulator improved performance during training in the supraclavicular approach to the subclavian vein, not as widely known or used as its infraclavicular counterpart.

Methods: To train anesthesiology residents to access a central vein, a mixed reality simulator with emulated ultrasound imaging was created using an anatomically authentic, 3D-printed, physical mannequin based on a computed tomographic scan of an actual human. The simulator has a corresponding 3D virtual model of the neck and upper chest anatomy. Read More

Front Pediatr 2017 5;5:211. Epub 2017 Oct 5.

Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France.

The correct choice of intra vascular access in critically ill neonates should be individualized depending on the type and duration of therapy, gestational and chronological age, weight and/or size, diagnosis, clinical status, and venous system patency. Accordingly, there is an ongoing demand for optimization of catheterization. Recently, the use of ultrasound (US)-guided cannulation of the subclavian vein (SCV) has been described in children and neonates. Read More

Pediatr Crit Care Med 2017 02;18(2):172-175

1Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, Paris, France. 2School of Medicine, Paris South University, Le Kremlin-Bicêtre, Paris, France. 3Institute of Integrative Biology of the Cell-UMR 9198, Paris Saclay University, Gif-sur-Yvette, Paris, France. 4Espace Ethique/IDF, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.

Objectives: Central venous access in critically ill, small infants remains technically challenging even in experienced hands. Several vascular accesses exist, but the subclavian vein is often preferred for central venous catheter insertion in infants where abdominal malformation and/or closure of the vein preclude the use of umbilical venous catheters, as catheterization of the subclavian vein is easier in very short necks than the internal jugular vein for age-related anatomical reasons. The subclavian vein approach is yet relatively undescribed in low birth weight infants (i. Read More

Crit Ultrasound J 2016 Sep;8(Suppl 1):12

Anaesthesiology Department, University Science of Malaysia, Kota Bharu, Malaysia.

Table Of Contents: A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Read More

Am J Emerg Med 2016 Sep 7;34(9):1761-4. Epub 2016 Jun 7.

Department of Emergency Medicine, University of California Irvine, Irvine, California.

Background: Point-of-care ultrasound guidance using a linear probe is well established as a tool to increase safety when performing a supradiaphragmatic cannulation of the internal jugular central vein. However, little data exist on which probe is best for performing a supradiaphragmatic cannulation of the subclavian vein.

Methods: This was a prospective, observational study at a single-site emergency department, where 5 different physician sonologists evaluate individual practice preference for visualization of the subclavian vein using a supraclavicular approach with 2 different linear probes and 1 endocavitary probe. Read More

J Vasc Access 2016 Sep 22;17(5):435-9. Epub 2016 Mar 22.

Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn - Germany.

Purpose: The ultrasound-guided central venous catheter (CVC) guidewire tip positioning has been demonstrated for catheterization of the right internal jugular vein. We explored the feasibility of an ultrasound-guided right subclavian vein (RScV) CVC tip positioning via a right supraclavicular approach using a microconvex probe.

Methods: Twenty patients scheduled for elective surgery were consecutively included in this observational feasibility study following written informed consent. Read More

Indian J Crit Care Med 2013 Jan;17(1):10-5

Department of Anesthesia and Intensive Care, St. Stephen's Hospital, Tis Hazari, New Delhi, India.

The supraclavicular approach was first put into clinical practice in 1965 by Yoffa and is an underused method for gaining central access. It offers several advantages over the conventional infraclavicular approach to the subclavian vein. At the insertion site, the subclavian vein is closer to the skin, and the right-sided approach offers a straighter path into the subclavian vein. Read More

J Vasc Access 2013 Jan-Mar;14(1):89-93. Epub 2012 Jul 23.

School of Anesthesia and Intensive Care Medicine, University of Pisa, Pisa, Italy.

Purpose: Ultrasound-guided (USG) central vein cannulation has become very popular among anesthesiologists and critical care physicians in the last decade and it has been advocated as the gold standard practice for internal jugular vein (IJV) catheterization.

Methods: We report a technique used at our second level hospital for cannulating either subclavian vein or innominate vein using a supraclavicular (SCV) approach under real time ultrasound guidance for elective positioning of long, medium or short-term central venous catheters (CVC). We report one year of practice. Read More

Paediatr Anaesth 2011 Nov 1;21(11):1136-41. Epub 2011 Jun 1.

Department of Anesthesiology, Hôpital mère enfant, 69500 Bron, France.

Background: Ultrasound (US) guidance techniques are reported to be safe for internal jugular vein catheterization, although anatomic conditions are not favorable for this approach in infants. The subclavian vein (SCV) seems to be a better site for long-term central venous catheterization in children, with a supraclavicular approach to avoid compression of the central venous catheter between the clavicle and the first rib ('pinch-off' syndrome). We describe a new US-guided approach for supraclavicular SCV cannulation in infants. Read More

J Cardiothorac Vasc Anesth 2011 Dec 7;25(6):1018-23. Epub 2011 Apr 7.

Department of Anesthesiology and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey.

Objective: To evaluate the clinical success rate, safety, and usefulness for intraoperative central venous pressure monitoring, and the intravenous access of the supraclavicular subclavian vein approach when compared with the infraclavicular subclavian vein approach and the internal jugular vein approach for central venous catheterization during open-chest cardiac surgery.

Design: A prospective, randomized, single-center study.

Setting: A university hospital. Read More

Anesthesiology 2009 Aug;111(2):334-9

Department of Anesthesia and Critical Care, Regional Medical Centre, Opole, Poland.

Background: Central venous catheters are commonly inserted for hemodynamic monitoring, volume monitoring, administration of medications, long-term total parenteral nutrition, access for renal replacement therapy, cardiopulmonary resuscitation, and difficult peripheral catheterization. The primary outcome of this study was to define venipuncture, catheterization and entire procedure success rates, and finally complication rate of subclavian venous catheterization via the supraclavicular approach with special focus on mechanically ventilated patients. The secondary outcome was to potentially make recommendations regarding this technique of central venous catheterization in mechanically ventilated patients. Read More

Curr Opin Organ Transplant 2009 Jun;14(3):281-5

Department of Anaesthesiology and Reanimation, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain.

Purpose Of Review: Central venous catheterization (CVC) is a procedure, not exempt of risk. Transplantation patients represent by themselves a high-risk group for CVC. Ultrasonography provides us of the exact localization of the target vein and its relationship with artery and nerve structures, detecting anatomic variations and thromboses of vessels. Read More

Semin Dial 2008 Sep-Oct;21(5):469-73. Epub 2008 Aug 29.

Department of Anesthesiology, Taipei-Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC.

Background: Because of overuse and multiple implantations of hemodialysis catheters through internal jugular or subclavian vein (SCV) in patients with chronic hemodialysis, these veins often become stenotic or occlude, therefore necessitating alternative access. We introduce a new technique in ventilated patients for placement of tunneled cuffed chronic hemodialysis catheter: modified supraclavicular approach by cease of ventilation.

Methods: Patients who received implantation of the tunneled cuffed chronic hemodialysis catheters by supraclavicular approach were collected from February 2003 to July 2005. Read More

J Vasc Access 2000 Jul-Sep;1(3):100-7

Departments of Surgery and Oncology, Catholic University, Rome - Italy.

There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent in-sertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein. Read More

Br J Anaesth 2007 Apr 1;98(4):509-14. Epub 2007 Mar 1.

Department of Anaesthesia, Université Catholique de Louvain, Cliniques universitaires St-Luc, Brussels, Belgium.

Background: Central venous cannulation in infants remains challenging even for experienced paediatric anaesthesiologists. Ultrasound (US)-guidance techniques are proven to be safer for internal jugular vein catheterization. But the subclavian vein (SCV) is often the preferred site for long-term central venous catheterization in children. Read More

Semin Dial 2004 Jul-Aug;17(4):307-9

Department of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.

This is a review of a new fluoroscopically guided safe technique to place tunneled cuffed hemodialysis (HD) catheters via the supraclavicular location. Right supraclavicular catheters were placed in 12 patients who had no patent internal jugular veins. The placements were all successful and without serious complications. Read More

Cal J Emerg Med 2004 Jul;5(3):50-4

Department of Emergency Medicine, University of California Irvine, Orange, California, USA.

Background: Central venous access is often necessary for the administration of fluids, blood products, and medications. Several approaches to supraclavicular subclavian venous access have been described. This study examines the effectiveness of central venous catheter placement utilizing an alternative set of anatomic landmarks for supraclavicular subclavian vein access. Read More

Anesth Analg 2000 Apr;90(4):784-9

Departments of Internal Medicine I, Division of Intensive Care, Vienna University Hospital, Vienna, Austria.

Unlabelled: Infraclavicular and internal jugular central venous access are techniques commonly used for temporary transvenous pacing. However, the procedure still has a considerable complication rate, with a high risk/benefit ratio because of insertion difficulties and pacemaker malfunction. To enlarge the spectrum of alternative access sites, we prospectively evaluated the right supraclavicular route to the subclavian/innominate vein for emergency ventricular pacing with a transvenous flow-directed pacemaker as a bedside procedure. Read More

Pathol Biol (Paris) 1999 Mar;47(3):269-72

Département Anesthésie-Analgésie-Réanimation, Institut Gustave-Roussy, Villejuif, France.

Mechanical complications of implanted venous access devices are more common than suggested by the literature. Among them, the most severe is catheter embolism, which is due primarily to costoclavicular pinch-off syndrome (POS). POS occurs mainly after infraclavicular approach of the subclavian vein, the incidence being 8/1000 in our experience. Read More

Bone Marrow Transplant 1998 Jun;21(11):1149-52

Department of Nephrology, University of Vienna, Austria.

The purpose of this study was to evaluate the efficacy and safety in placement of Hickman catheters via the supraclavicular route without fluoroscopic guidance. We studied 81 consecutive percutaneous placements of dual lumen Hickman catheters via the supraclavicular route without the use of fluoroscopic guidance. Success rates, technical problems, complications, infections and reasons for explantation were recorded prospectively. Read More

Am J Kidney Dis 1997 Dec;30(6):802-8

Department of Nephrology, University of Vienna, Austria.

Infraclavicular and internal jugular catheterization are commonly used techniques for hemodialysis access, but may at times be impeded in patients whose anatomy makes cannulation difficult. In an effort to enlarge the spectrum of alternative access sites, we evaluated the supraclavicular approach for large-bore catheters. During an 18-month period we prospectively collected data on success rate and major and minor complications of the supraclavicular access for conventional dialysis catheters as well as Dacron-cuffed tunneled devices in 175 adult patients admitted for various extracorporeal therapies and bone marrow transplantation. Read More

Wien Klin Wochenschr 1997 Jun;109(11):400-5

Department of Nephrology and Dialysis, University of Vienna, Austria.

Introduction: Proper placement is an essential prerequisite for the use of central venous catheters. Our study was undertaken to determine the incidence of aberrant locations dependent on different anatomic approaches for various types of central venous catheters and to elucidate failures and pitfalls of preventive practices.

Methods: 2580 percutaneously inserted lines (including 538 tunneled devices and 112 implantable Port-A-Caths) introduced by Seldinger's technique were reviewed for inadvertent malpositioning. Read More

J Trauma 1997 Feb;42(2):305-9

Mercy Catholic Medical Center (Mercy Hospital), Philadelphia, Pennsylvania, USA.

Over a period of 15 months, 178 consecutive attempts at supraclavicular catheterization of the subclavian veins were performed by the same operator. There were 42 additional central lines inserted during this period, which were placed via other methods as specified by the attending physicians. Results of the supraclavicular approach are presented and are believed to be the largest reported series of supraclavicular line insertions by one operator. Read More

South Med J 1992 Jul;85(7):725-8

Division of Vascular Surgery, Francis Scott Key Medical Center, Baltimore, Md. 21224.

The percutaneous supraclavicular approach for temporary central venous hemodialysis access was successfully used in 27 of 34 cases (79%) without significant complications and was found to be a durable technique acceptable to every patient. The supraclavicular site was used from 3 to 156 days (mean, 40 days). The average catheter life was 25 days, and 13 guidewire catheter changes among eight patients were required for catheter limb thrombosis or suspected infection. Read More

Gynecol Oncol 1989 Jun;33(3):313-6

Wayne State University, Hutzel Hospital, Detroit, Michigan 48201.

From December 1986 through July 1987, forty-one Groshong catheters were inserted in 38 patients with invasive gynecologic cancer for a cumulative total of 4170 days of patient use. (mean catheter indwelling time: 93 days; range: 3-300 days). A supraclavicular approach was used to cannulate the brachiocephalic vein in 31 patients. Read More

JAMA 1982 Jun;247(23):3227-30

Percutaneous access to the central venous circulation is indicated in the management of some cardiopulmonary arrests. We prospectively studied 89 attempted subclavian vein catheterizations in a total of 76 patients. There were 44 supraclavicular (SC) and 45 infraclavicular (IC) approaches. Read More