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GENERAL ARTICLES

A Novel Supraclavicular Approach to the Right Subclavian Vein Based on Three-Dimensional Computed Tomography

Chul-Woo Jung, MD^*, Jeong-Hwa Seo, MD^*, Whal Lee, MD, and Jae-Hyon Bahk, MD^*

From the Departments of *Anesthesiology and Pain Medicine, and Radiology, Seoul National University Hospital, Seoul, Korea.

Address correspondence and reprint requests to Jae-Hyon Bahk, MD, Department of Anesthesiology, Seoul National University College of Medicine, No. 28, Yongon-Dong, Jongno–Gu, Seoul 110-744, Korea. Address e-mail to bahkjh{at}plaza.snu.ac.kr.

BACKGROUND: We used three-dimensional (3-D) computed tomography to develop a novel supraclavicular approach to the subclavian vein that minimizes the distance from insertion site to the vein.

METHODS: Forty-five adult patients with normal body build were retrospectively included in the 3-D computed tomography investigation. Assuming that the clavisternomastoid angle was the skin entry point, and that the subclavian vein on the first rib was a target, the optimal angle of approach was measured on the simulated 3-D images. A 3-D video was developed from these images to explain the approach. In a pilot study, we prospectively tested this approach in 60 adult patients with normal body build requiring central venous catheterization. The number of attempts, success rate, and complications were noted.

RESULTS: The optimal angle of approach was 10.6° ± 5.3° medially and 35.4° ± 12.5° posteriorly from the skin entry point. The estimated depth of the subclavian vein was 13.7 ± 3.1 mm. During the pilot study, the first trial with a finder needle was successful in 87% of patients and the overall success rate of catheterizations was 100% without complications.

CONCLUSIONS: The proposed supraclavicular approach to the subclavian vein is a simple method of central venous catheterization. The pilot study suggests the method is reasonably safe. The video explaining the approach graphically is available in the supplementary material.