We read with interest the work by Saugel et al. [1] about ultrasound-guided central venous catheter placement.
In their work the authors accurately describe “in-plane” and “out of plane” techniques for central venous catheter access. However, they describe only briefly the oblique-axis technique and for this approach only articles about internal venous jugular catheterization are cited [2, 3] and nothing in the literature about the oblique axis for subclavian access could be found.
In our experience we make regular use of the oblique-axis technique for placing subclavian catheters with a high success rate and a low rate of complications. An important aspect for a successful procedure is patient positioning; in fact, the best visualization of the subclavian vein and artery is, in our experience, possible with a 90° abduction of the arm. After aseptic preparation the ultrasound probe is covered with a protective plastic sheath. Ultrasound inspection is started laterally near the axilla to identify the axillary vein and artery in a classic “out of plane” view, after which the vessels are followed until the joint point of the axillary vein with the cephalic vein (Fig. 1): this is the anatomic subclavian starting point. After a 45° rotation of the probe an oblique view is then possible (Fig. 2). It is an easy method with great advantages in comparison with “in-plane” and “out of plane” views because it permits both visualization of the tip of the needle and important anatomical structures such as the artery or vein (both with an oval shape due to projection) and, moreover, sliding of the lung.
References
Saugel B, Scheeren TWL, Teboul J-L. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017;21:225. https://doi.org/10.1186/s13054-017-1814-y.
Phelan M, Hagerty D. The oblique view: an alternative approach for ultrasound-guided central line placement. J Emerg Med. 2009;37:403–8. https://doi.org/10.1016/j.jemermed.2008.02.061.
Wilson JG, Berona KM, Stein JC, Wang R. Oblique-axis vs. short-axis view in ultrasound-guided central venous catheterization. J Emerg Med. 2014;47:45–50. https://doi.org/10.1016/j.jemermed.2013.11.080.
Acknowledgements
None.
Funding
None.
Availability of data and materials
Not applicable.
Author information
Authors and Affiliations
Contributions
ADC was responsible for conceptualization, writing and the original draft of the manuscript. HG was responsible for writing, review and editing of the manuscript. Both authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Additional information
See related review by Saugel et al., https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1814-y
Rights and permissions
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.
About this article
Cite this article
De Cassai, A., Galligioni, H. Subclavian oblique-axis catheterization technique. Crit Care 21, 323 (2017). https://doi.org/10.1186/s13054-017-1915-7
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s13054-017-1915-7