Journal of the Chinese Medical Association
Volume 69, Issue 4 , Pages 153-156, April 2006

Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Infants

  • Wen-Hsien Lu

      Affiliations

    • Division of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • National Defense Medical Center, Taipei, Taiwan, R.O.C.
    • ,
  • Mei-Ling Yao

      Affiliations

    • Department of Nutrition and Health Science, Fooyin University, Kaohsiung, Taiwan, R.O.C.
    • ,
  • Kai-Sheng Hsieh

      Affiliations

    • Division of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • National Defense Medical Center, Taipei, Taiwan, R.O.C.
    • ,
  • Pao-Chin Chiu

      Affiliations

    • Division of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • National Defense Medical Center, Taipei, Taiwan, R.O.C.
    • ,
  • Ying-Yao Chen

      Affiliations

    • Division of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • National Defense Medical Center, Taipei, Taiwan, R.O.C.
    • ,
  • Chu-Chuan Lin

      Affiliations

    • Division of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • National Defense Medical Center, Taipei, Taiwan, R.O.C.
    • ,
  • Ta-Cheng Huang

      Affiliations

    • Division of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • National Defense Medical Center, Taipei, Taiwan, R.O.C.
    • ,
  • Chu-Chin Chen

      Affiliations

    • Division of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • National Defense Medical Center, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr. Chu-Chin Chen, Division of Pediatrics, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan, R.O.C.

Received 24 August 2005; accepted 24 February 2006.

Article Outline

Background

Central venous catheterization is an important procedure for infant patients for a number of different purposes, including nutritional support, surgical operation, hemodynamic monitoring, and multiple lines for critical care medications. Subclavian vein catheterization (SVC) is one of the central vein catheterization techniques. SVC can be performed from 4 different locations: right supraclavicular (RSC), left supraclavicular (LSC), right infraclavicular (RIC), and left infraclavicular (LIC). The purpose of this study was to evaluate the relative effectiveness and complication risks of these 4 SVC locations in infants.

Methods

In our pediatric intensive care unit, which is part of a tertiary medical center, a well-trained fellow doctor performed the following catheterizations: 21 RSC, 24 LSC, 24 RIC, and 22 LIC, for a total of 91 SVC operations in infants. The patients were placed in the Trendelenburg position. The site of puncture was decided by the operator. Statistical significance was analyzed according to Fisher's exact test and 2-sample t test.

Results

The overall success rate was 90.1% (82 out of 91 operations). No statistically significant differences were noted among these 4 groups, either in the success or complication rate. There were 6 cases of arterial puncture (5 supraclavicular and 1 infraclavicular, p = 0.09), 2 cases of pneumothorax (1 RSC and 1 RIC), and 2 cases of malpositioned catheter (1 RSC and 1 RIC). There was no mortality.

Conclusion

In our study, we found that there was no statistically significant difference among the 4 SVC locations in effectiveness of operation or in risk of complication. There was a tendency to damage the subclavian arteries through the supraclavicular route.

Key Words:  central catheterization , complications , infants , pneumothorax , subclavian vein

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PII: S1726-4901(09)70196-0

doi:10.1016/S1726-4901(09)70196-0

Journal of the Chinese Medical Association
Volume 69, Issue 4 , Pages 153-156, April 2006

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