정맥로 확보를 위한 쇄골하정맥 도관법

Abstract

A reliable intravenous route is extremely important not only in surgical patients for prolonged administration of fluids and massive transfusion but also in patients with peripheral vascular collapse for hyperalimentation and critical patients.

Since the subclavian vein catheterization in a supraclavicular approach was introduced by J. K. Jeon in 1974 in our institution, it has been extremely popular for a prolonged intravenous administration of fluids rather than for the measurement of central venous pressure. Thereafter, the method of supraclavicular cannulation was modified by way of a more simple and easy method, using a 2 inch Angiocath instead of an 8 inch Intracath.

We had 200 cases of Supraclavicular Subclavian vein cannulation which were done in various surgical patients of all ages. We have observed the following advantages of this method (2 inch angiocath) over the previous method.

1) No bleeding around the catheter.

2) Simple and easy technique.

3) Easy to fix the catheter.

4) No need to wear gloves.

5) Less complications such as air and catheter embolism.

6) Bigger internal diameter in the Angiocath even with the same size.

7) Easy to keep the catheter open.

8) Cheaper.

The subclavian vein is located within the costo-clavicular-scalene triangle and is approximately 3 to 4cm long and 1 to 2cm in diameter in adults. The patient is placed in a supine and trandelenburg position to allow the subclavian vein to distend and to help prevent an air embolism when the vessel is cannulated.

Following the preparation of the supraclavicular fossa, a 2 inch Angiocath with a lOcc syringe attached is inserted and advanced in the direction of the innominate vein, approximately 1cm from the junction of the clavicle and the lateral border of the sternocleidomastoid muscle (Clavisternomastoid angle, fig. 2).

It is important to maintain a negative pressure while advancing the needle untill a free flow of blood is observed in the syring. When blood is observed in the syringe, a catheter is inserted and threaded ail the way to the end then the needle is removed. The tip of the catheter is connected to the intravenous solution and fixed with adhesive tape. There is no need to press the puncture site or change the position in order to prevent bleeding around the catheter.

The complications of a subclavian vein cannulation with an Angiocath are the same as with an Intracath. Those are pneumothorax, hydrothorax, hemothorax, air embolism, hematoma, catheter embolism, thrombosis and sepsis but the incidence is lower in this method. In the supraclavicular cannulation in our series, we have not experienced any of the above complications among the 200 cases done here due to the fact that only a few well qualified doctors have performed this technique.