Effect of improved right subclavian vein catheterization on the direction of catheter tip in children

Background: Catheter tip malposition frequently occurs with subclavian vein catheterization.The supine position returns more and faster blood to the heart than the head down position.It is assumed that the soft catheter is easy to follow the flow forward. This study investigates the influence of catheter flexibility and position on right subclavian catheter placement. Methods. Patients who required subclavian venipuncture catheterization at the Department of Hematology and oncology, Shenzhen Children's hospital were randomly divided into two groups: test group A (80 patients) vs control group B (81 patients).Group A was in the flat position, and the guide wire was partially retracted during catheter placement.Group B used the traditional method of catheterization.Intraoperative ultrasound was used to check the direction of the catheter tip and postoperative chest X-ray was performed. Results. The correct rate of catheter tip orientation at the first insertion in group A was higher than that in group B (86.2% vs 66.7%, P < 0.05), and the rate of catheter misplacement in right internal jugular vein in group A was lower than that in group B (10.0% vs 29.6%, P < 0.05). The incidence of intraoperative arrhythmia in group A was lower than that in group B (0.0% vs 14.8%, P < 0.05).No significant differences in general data and other complications between them. Repeated catheterization failed in 5 patients,and other methods were used for catheterization. Conclusions. The use of the guide wire in the supine position can reduce catheter malposition in children with right subclavian vein catheterization.