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Objective To evaluate the feasibility of catheterization of subclavian vein via supra-clavicular puncture in children less than six years of age, in comparison with subclavian vein catheterization via infraclavicular puncture and cannulation of internal jugular vein (IJV) from a high medial approach. Methods One hundred and eighty children (104 male, 76 female) aged 15 d-6 yr, undergoing major surgery were randomly divided into 3 equal groups of 60 patients: group I subclavian vein catheterization via supra-clavicular puncture; group Ⅱ subclavian vein catheterization via infra-clavicular puncture and group Ⅲ IJV catheterization from a high medial approach. (1) The overall success rate of puncture, (2) the success rate of puncture at first attempt, (3) the success rate of cannulation, (4) the duration from beginning of puncture to aspiration of blood, (5) the duration from the beginning of puncture to successful cannulation and (6) complication were recorded. Chest X-ray was taken in 30 patients in group I for confirmation of the position of catheter in subclavian vein. Results (1) The overall success rate of puncture was 100% and the success rate of puncture at first attempt was 86.67% in group I significantly higher than those in group Ⅱ (91.96% and 51.67%) and group Ⅲ (93.33% and 58.33%) (P
RESUMO
Objective To evaluate the effectiveness and safety of percutaneous subclavian venous catheterization through the point of insertion medial to the middle of clavicle in infants.Methods One hundred and fifty infants(88 male,62 female)aged 1-12 months scheduled for major operation were enrolled in this study. Subclavian venous catheterization was performed via supraclavicular approach.The needle was inserted at a point midway between the middle of clavicle and the inner third of clavicle(group Ⅰ,n=50)or at the point where the posterior border of sterno-cleidomastoid muscle(SCM)meets the upper border of clavicle(Yoffa method group Ⅱ, n=50)or at the posterior border of SCM,0.5-1.0 cm above the upper border of clavicle(modified James method,group Ⅲ,n=50).The overall success rate,the success rate at first attempt,the failure rate,the depth of insertion and complications were recorded.Results The 3 groups were comparable with respect to sex ratio,age and body weight.There were no significant differences in overall success rate and failure rate among the 3 groups. The success rate at first attempt in group Ⅰ(86%)was significantly higher than that in group Ⅱ(74%)and group Ⅲ(80%)(P＜0.05).The depth of insertion was significantly greater in group Ⅰ[(2.21+0.28)cm]than in group Ⅱ[(1.79?0.33)cm]and group Ⅲ[(1.84?0.38)cm].No pneumothorax and in advertent arterial puncture and nerve injury occurred in the 3 groups.Conclusion Supraclaricular subclavian venous catheterization through the insertion point medial to the middle of clavicle is better than the conventional methods(Yoffa,James) in terms of success rate at first attempt in infants.