[Ultrasound-guided infraclavicular venipuncture at the junction of the axillary and subclavian veins]. / Ultraschallgestützte infraklavikuläre Punktion am Übergang der V. axillaris in die V. subclavia.

BACKGROUND: Compared to other access routes a central venous catheter inserted via the subclavian vein (VS) is advantageous in terms of patient comfort, care of the puncture site and the infection rate. Puncture of the VS admittedly has a higher risk of mechanical complications but ultrasound guidance can reduce this risk; however, it is technically demanding due to anatomical peculiarities and this access route is therefore used comparatively less frequently. AIM: The aim of the study was to clarify to what extent a modified puncture technique guided by sonography can reduce the risk potential. MATERIAL UND METHODS: A technique is presented in which the infraclavicular insertion site is laterally shifted in the direction of the axillary vein (VA). RESULTS: When the vein is visualized by sonography in the long axis the accompanying artery and the pleura remain outside the ultrasound plane. By doing so, a needle that is strictly guided in the imaging plane can barely damage these structures even if accidentally inserted too deep as they lie outside of the needle trajectory. CONCLUSION: This presented technique can provide benefits for operators experienced in in-plane puncture.

[Epidural malpositioning of an interscalene plexus catheter]. / Epidurale Fehllage eines interskalenären Plexuskatheters.

A patient received an interscalene plexus catheter before shoulder surgery. After induction of general anesthesia catheter placement was performed with Winnie's technique and 5 ml of ropivacaine was injected via the catheter. In the recovery room slight dyspnea without wheezing was observed which improved spontaneously. Following another bolus of ropivacaine, dyspnea and paralysis of the contralateral arm developed and the patient became hypotensive. The tomography scan showed epidural malpositioning of the catheter. Neuraxial complications of interscalene regional anesthesia are especially possible with medially directed insertion of the needle and have been described many times in the literature. The symptoms and recommendations for prevention are discussed.