Anatomical Basis for Supraclavicular Central Venous Catheterization Assessed by Three-Dimensional Computed Tomography / 대한마취과학회지

ABSTRACT

BACKGROUND: The current study aimed at elucidating the anatomical basis for a supraclavicular approach for central venous catheterization using three-dimensional computed tomography (3D-CT). METHODS: Retrospective review of CT images from 60 adult patients with normal body build was performed using 3D-CT reconstruction. Right-sided approach was assumed, and the skin entry point was decided as a point above the subclavian vein at the supraclavicular fossa. Measured parameters were; angles of the clavicle (Aclv) and the subclavian vein (Ascv) to the coronal plane, the distance from the clavisternomastoid angle to the skin entry point (Dse), the optimal angle of needle insertion (Ains) targeting the confluence between the internal jugular vein and the subclavian vein, the distance from the skin entry point to the confluence (Dconf), and the diameter of the confluence (Dia). Descriptive statistics were performed for the measured values. Correlation test was performed between Ascv and Aclv. RESULTS: Measured values were; Aclv = 8.0 degrees, Ascv = 5.7 degrees, Dse = 12.5 mm, Ains = 40 degrees, Dconf = 20.5 mm, and Dia = 18.1 mm. Ascv demonstrated positive correlation with corresponding Aclv (r = 0.494, P < 0.001). CONCLUSIONS: Optimal guideline for the supraclavicular approach can be provided via 3D-CT investigation. Forty degrees of needle direction to the sagittal plane and parallel to the posterior surface of the clavicle, at 1.3 cm posterior to the clavisternomastoid angle insures proper puncture of the confluence without anticipated complications.