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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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TECHNICAL NOTES  CRITICAL AND INTENSIVE THERAPY


Minerva Anestesiologica 2001 May;67(5):401-6

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Alternative technique for subclavian vein cannulation

Ferraro F., D’Ignazio N., Meglio M., Marra M., Rusciano G., Odierna I., Capasso A., Belluomo Anello C.

Seconda Università ­degli Studi - Napoli Dipartimento di Anestesia e Rianimazione Servizio di Terapia Intensiva


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Background. Subclavian ­vein cathet­er­ism, a com­mon­ly ­used meth­o­dol­o­gy in ICU, is not ­devoid of com­pli­ca­tions, ­even ­some seri­ous ­ones (Pneumothorax 0-5%).
Methods. The authors pro­pose an alter­na­tive tech­nique ­based on the use of an intro­duc­er nee­dle ­bent on its own ­axis to ­form an ­arch ­with its con­cav­ity ­turned ­towards the Quincke ­point. On search­ing the ­blood ves­sel, ­once the sub­cla­vian ­plane has ­been ­reached, the nee­dle advance­ment ­towards the jug­u­lar ­fosse hap­pens by fol­low­ing the nee­dle cur­va­ture. In ­this way the oper­a­tor can ­keep the nee­dle on a ­plane par­allel to the cuta­ne­ous one, and all the com­pli­ca­tions due to invol­un­tary exceed­ing of the ­costal ­plane are avoid­ed. The ­response of ­this new tech­nique in 110 ­patients (­study ­group) is com­pared ­through a ret­ro­spec­tive ­study, to 100 ­patients ­with ­whom the stan­dard tech­nique has ­been ­used (con­trol ­group).
Results. The ­study ­group has pre­sent­ed a sig­nif­i­cant reduc­tion ­both of ­total com­pli­ca­tions (p<0.05) and of ­total fail­ures (p< 0.01).
Conclusions. Such ­results, ­although per­ti­nent to a ­still lim­it­ed ­study, tes­ti­fy to an improve­ment in ­terms of secur­ity and effi­ca­cy, ­with the new alter­na­tive tech­nique with­out an ­increase in ­costs.

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