Shrestha Critical Care (2018) 22:148 https://doi.org/10.1186/s13054-018-2075-0 LETTER Open Access Longing for better ultrasound-guided subclavian/axillary venous cannulation Gentle Sunder Shrestha Received: 29 April 2018 Accepted: 21 May 2018 Ultrasound guidance for central venous catheter (CVC) placement reduces complications, increases safety and en- hances the quality of the procedure . Existing guidelines References 1. Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous suggest a higher level of evidence for ultrasound-guided catheter placement: a structured review and recommendations for clinical internal jugular venous cannulation compared with the practice. Crit Care. 2017;21:225. subclavian/axillary route . Meta-analysis of trials study- 2. Frankel HL, Kirkpatrick AW, Elbarbary M, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of ing the use of ultrasound guidance for subclavian venous critically ill patients – part I: general ultrasonography. Crit Care Med. cannulation, when compared with the landmark tech- 2015;43:2479–502. nique, showed decreased incidence of arterial puncture 3. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. and hematoma formation, but there was no overall differ- Cochrane Database Syst Rev. 2015;1:CD011447. ence in complications and success rates . 4. Ahn JH, Kim IS, Shin KM, et al. Influence of arm position on catheter Smaller studies have shown that patient positioning dur- placement during real-time ultrasound-guided right infraclavicular proximal axillary venous catheterization. Br J Anaesth. 2016;116:363–9. ing cannulation of the subclavian vein (e.g., turning the 5. Sadek M, Roger C, Bastide S, et al. The influence of arm positioning on head to the contralateral side, shoulder-pulled-downward ultrasonic visualization of the subclavian vein: an anatomical ultrasound position, and abducted position of arm) can alter the rela- study in healthy volunteers. Anesth Analg. 2016;123:129–32. tionship between the subclavian vein and the internal jugular vein and can also alter the cross-sectional area of the vein, thus potentially affecting the safety and success of cannulation [4, 5]. Further well designed studies should try to explore the influence of these various patient positions on ultrasound-guided subclavian venous cannulation. Abbreviation CVC: Central venous catheter Authors’ contributions GSS contributed to the concept, design, literature search, manuscript writing, editing, and review. The author read and approved the final manuscript. Competing interests The author declares that he has no competing interests. Publisher’sNote Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Correspondence: email@example.com Department of Anaesthesiology, Critical Care Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Critical Care – Springer Journals
Published: Jun 5, 2018
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