Which Position is Ideal for Subclavian Venous Catheterization?

Ryu, Ji Ho; Yeom, Seok Ran; Jeong, Jin Woo

Abstract

PURPOSE: We postulated that the success rate for subclavian venous catheterization could be enhanced by improving body positioning. The purpose of this study was to determine the optimal positioning. The ideal position should result in the largest antero-posterior diameter of the subclavian vein and the shortest depth from the skin to the subclavian vein.
METHODS
We used 7.5MHz linear probe. Eighteen adult volunteers underwent ultrasound imaging of the right subclavian vein while supine in the following eight positions: NP/PO/AT, NP/PO/AN, NP/PX/AT, NP/PX/AN, LP/PO/AT, LP/PO/AN, LP/PX/AT, LP/PX//AN (neutral head position, NP; head turned to left, LP; on pillow, PO; off pillow, PX; arm traction, AT; neutral arm position, AN). We checked the antero-posterior diameter of the subclavian vein and the depth from skin to the subclavian vein in each position. Statistical significance was determined using Wilcoxon's signed rank test.
RESULTS
The antero-posterior diameter of the subclavian vein in NP/PX/AN position is largest and in LP/PO/AN position is smallest (p=0.01). The difference of the depths from skin to the subclavian vein in each positions is not significant statistically.
CONCLUSION
There was no statistically significant effect of head position on the antero-posterior diameter of the subclavian vein or on the depth from the skin to subclavian vein. Arm traction did not result in an increase in the anteroposterior diameter. Positioning on the pillow likewise conferred no advantage in the antero-posterior diameter. The most optimal position for subclavian venous catheterization was the neutral head position without pillow between the scapulas and without the arm retracted position.