Risk factors and early indicators for misplacement of subclavian vein catheter into ipsilateral internal jugular vein

Abstract

Objective To identify the risk factors and early indicators for misplacement of subclavian vein catheter into ipsilateral internal jugular vein.Methods From August 2008 to July 2009,subclavian vein catheterization was successfully performed with Seldinger method in 167 patients in Department of General Surgery,Xuanwu Hospital of Capital Medical University.The paraeentesis side,pameentesis site,direction of puncture needle.and the perceptions of both patients and operators during catheter placement were recorded.The correlation of these factors,age,and gender with the misplacement of subclavian vein catheter into internal jugular vein was analyzed.Results Sixteen patients(9.58%)experienced misplacement of subclavian vein catheter into ipsilateral internal jugnlar vein,which was not significantly correlated with age(P=0.375),gender(P=0.259),paraeentesis side (P=0.175),or paracentesis site(P=0.061).Misplacement of subclavian vein catheter into internal jugular vein was significantly more frequent when the direction of puncture needle was toward the midpoint of suprasternal fossa and laryngeal prominence(P=0.002).When the paracentesis site was located at a point at the junction of medial one-third and lateral two-tllirds of the clavicle.it was more frequent that the puncture needle was toward the midpoint of suprasternal fossa andlaryngeal prominence(P=0.010).There were more misplacement events when the patients feel ears pain(P=0.000)and when the operator felt resistance when inserting gnidewire during catheter placement(P=0.000).Conclusions Misplacement of subclavian vein catheter into ipsilateral internal jugnlar vein occurs more frequently when the direction of puncture needle is towards the midpoint between suprasternal fossa and laryngeal prominence.Patients feel ears pain and operators feel resistance when inserting guidewire during catheter placement are early indicators of misplacement. Key words: Subclavian vein; Internal jugular vein; Catheter misplacement