Internal jugular vein malposition of subclavian catheters. Prevention and detection

A prospective analysis of 110 consecutive right-sided infraclavicular subclavian catheterizations in 102 patients is presented. Alternate patients were assigned into one of two groups (55 patients in each), to assess the value of ipsilateral head turning and supraclavicular pressure in preventing internal jugular vein (IJV) malposition of the catheter tip. Two malpositions occurred in the trial group (3.6%) and five occurred in the control group (9.1%). Although the manoeuvre reduced the incidence of malposition, the difference was not statistically significant (P = 0.22). A further 100 infraclavicular catheterizations were analysed to assess a new auscultatory test to predict IJV malposition of subclavian catheters. The test led to accurate prediction of all six malpositions. There were no false negative findings, but one false positive prediction was made. Results of this study suggest that the routine use of head turning may not prevent IJV malposition. However, the auscultatory test accurately predicts this malposition, and its routine use after subclavian catheterization is recommended.