Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2017 Vol. 25 No 3

NEW METHODS

DOI: https://dx.doi.org/10.18484/2305-0047.2017.3.306   |  

A.N. OSMOLOVSKY

THE SUBCLAVIAN VEIN PUNCTURE TECHNIQUE

EE "Vitebsk State Medical University",
Vitebsk
The Republic of Belarus

Objectives. To work out the effective and safe technique of the subclavian vein puncture without damaging dome of the pleura and pneumothorax.
Methods. The subclavian vein puncture by the own original methodology was carried out in 34 patients aging from 19 to 88 years (the main group). Control group consisted of 50 cases of the subclavian vein catheterization in the manner of Aubaniac. 50 case histories of patients were selected by the continuous sampling method. The incidence of major complications after the subclavian vein puncture was analyzed in patients of the main and control groups including unsuccessful puncture on the selected side (failed puncture); damage of the subclavian artery; subcutaneous hematoma; pneumothorax; damage of the internal thoracic duct, trachea; thrombotic complications. The data which is given in the literature on the puncture-related complications of central veins were taken for the standard.
Results. All major complications of the subclavian vein puncture were registered in the control group, except for the damage of the thoracic duct and the trachea. The incidence of major complications in the control group was in the digital range of literature data that indicates the independent nature of the complications in using the same methodology under different conditions. Only two kinds of complications, unsuccessful puncture (6%) and subcutaneous bruise (6%) were registered in the main group. The incidence of these complications was comparable with the results of the control group and literature data. At the same time this group had no serious complications such as pneumothorax, subclavian artery damage and thromboembolic complications.
Conclusion. The designed technique of the subclavian vein puncture permits to avoid the subclavian artery injury, damaging the dome of the pleura and pneumothorax and is considered to be more effective and safer than the existing methods.

Keywords: subclavian vein, puncture of the subclavian vein, complications of vein catheterization, pneumothorax, dome of the pleura, subcutaneous hematoma
p. 306-311 of the original issue
References
  1. Sukhorukov VP, Berdikian AS, Epshtein SL. Punktsiia i kateterizatsiia ven. Traditsionnye i novye tekhnologii [Puncture and catheterization of veins. Traditional and new technologies]. Vestn Intensiv Terapii. 2001;(2):83-87
  2. Buniatian AA, Mizikov VM. Anesteziologiia [Anesthesiology]: nats ruk. Moscow, RF: GEOTAR-Media; 2011. 1104 p.
  3. Kilbourne MJ, Bochicchio GV, Scalea T, Xiao Y. Avoiding common technical errors in subclavian central venous catheter placement. J Am Coll Surg. 2009 Jan;208(1):104-9. doi: 10.1016/j.jamcollsurg.2008.09.025.
  4. Cunningham SC, Gallmeier E. Supraclavicular approach for central venous catheterization: "safer, simpler, speedier". J Am Coll Surg. 2007 Sep;205(3):514-16; author reply 516-17.
  5. Czarnik T, Gawda R, Perkowski T, Weron R. Supraclavicular approach is an easy and safe method of subclavian vein catheterization even in mechanically ventilated patients: Analysis of 370 attempts. Anesthesiology. 2009;111:334-39. doi: 10.1097/ALN.0b013e3181ac461f.
  6. Chernykh AV, Isaev AV, Vitchinkin VG, Kotiukh VA, Iakusheva NV, Levteev EV, i dr. Punktsiia i kateterizatsiia podkliuchichnoi veny: ucheb-metod posobie dlia studentov i vrachei [Puncture and catheterization of the subclavian vein: a tutorial method for students and physicians]. Voronezh, RF; 2001. 30 p.
  7. Aubaniac R. A new route for venous injection or puncture: the subclavicular route, subclavian vein, brachiocephalic trunk. Sem Hop. 1952 Nov 18;28(85):3445-47. [Article in Undetermined Language]
  8. Yoffa D. Supraclavicular subclavian venepuncture and catheterisation. Lancet. 1965 Sep 25;2(7413):614-17.
  9. Kuz'kov VV, Kirov MIu. Invazivnyi monitoring gemodinamiki v intensivnoi terapii i anesteziologii [Invasive monitoring of hemodynamics in intensive care and anesthesiology. Description]. Opisanie. Arkhangel'sk, RF: SGMU; 2008. 244 p.
  10. Orci LA, Meier RP, Morel P, Staszewicz W, Toso C. Systematic review and meta-analysis of percutaneous subclavian vein puncture versus surgical venous cutdown for the insertion of a totally implantable venous access device. Br J Surg. 2014 Jan;101(2):8-16. doi: 10.1002/bjs.9276.
  11. Rouzen M, Latto IaP, Sheng U. Chreskozhnaia kateterizatsiia tsentral'nykh ven [Transcutaneous catheterization of central veins]. Eremenko AA, per s angl. Moscow, RF: Meditsina; 1986. 158 p.
  12. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003 Mar 20;348(12):1123-33.
  13. Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001 Aug 8;286(6):700-7.
  14. Sutingko AN, Nel'son B, Nobl' VE. UZI pri neotlozhnykh i kriticheskikh sostoianiiakh [Ultrasound in urgent and critical conditions]. Moscow, RF: Med lit; 2009. 240 p.
  15. Bransky A, Frankel H. Do not insert, change, or remove a central line with the patient sitting up. In: Marcucci L, Martinez EA, Haut ER, Slonim AD, Suarez JI, eds. Avoiding Common ICU Errors. Philadelphia: Lippincott Williams&Wilkins; 2007. р. 136-37.
  16. Fortune JB, Feustel P. Effect of patient position on size and location of the subclavian vein for percutaneous puncture. Arch Surg. 2003 Sep;138(9):996-1000; discussion 1001.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze pr., 27, EE "Vitebsk State Medical University",
Department of anesthesiology and reanimation with the course of FPK and PK,
Tel.: 375 29 599 17 97,
E-mail: Lariza_1970@mail.ru,
Aleksander N. Osmolovsky
Information about the authors:
Osmolovsky A.N. PhD, Ass. Professor of department of anesthesiology and intensive care with the course of the faculty of the advanced training and retraining of medical specialists, EE "Vitebsk State Medical University"
Contacts | ©Vitebsk State Medical University, 2007