Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach

Abstract

Objective Comparing the influence of neutral shoulder and lowered shoulder on central venous catheter tip location during infraclavicular cubclavian approach.Methods 359 patients who required subclavian central venous catheterization were randomly divided into two groups:neutral (n =179) and lowered (n =180) shoulder position.In Group C,the right shoulder was kept in the neutral position during venipuncture and guide-wire insertion.Postoperative chest radiographs were obtained to identify the location of catheter tips.Results Aberrant placement of the catheter tips in group Ⅰ [14 (7.8％)] was more frequent than that in group C [2 (1.1％)] (P ＜ 0.01),and then the incidence of misplaced catheter tips in either the ipsilateral internal jugular vein or the contralateral brachiocephalic vein in group Ⅰ [8 (4.4％),6 (3.3％)] was significantly higher than that in group C [2 (1.1％),0,P＜0.01].Conclusion The neutral shoulder position minimizes the number of needle passes and the incidence of catheter misplacement during the infraclavicular approach of the right subclavian vein catheterization. Key words: Subclavian veins; Infraclavicular cubclavian approach; Catheter tip misplacement