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The Effect of Full Expiration on the Position and Size of the Subclavian Vein in Spontaneously Breathing Adults.
MedLine Citation:
PMID:  22763901     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background:If full expiration during subclavian venous cannulation increases the distance between the subclavian vein (SCV) and the pleura or increases the diameter of the vein, it might decrease the incidence of pneumothorax and/or increase the success rate of venous cannulation. In this study, we evaluated the effect of full expiration on the distance from the SCV to the pleura and on the cross-sectional area (CSA) of the SCV in spontaneously breathing adults.Methods:The distance from the inferior border of the right SCV and the pleura (SCVinf-Pleura distance), the distance from the center of the vein to the pleura (SCVcen-Pleura distance), and the CSA of the vein were measured using ultrasound at the end of inspiration and at the end of full expiration in 20 adults placed in the horizontal position. The subjects were then placed in 15° Trendelenburg tilt, and the distances and the CSA were measured again.Results:The SCVcen-Pleura distances were changed minimally in the horizontal position (0.005 cm, 95% confidence interval [CI] -0.04 to 0.05) and in the Trendelenburg position (0.02 cm, 95% CI -0.005 to 0.05). The SCVinf-Pleura distances decreased at the end of full expiration in the horizontal position, but the change was only 0.07 cm (95% CI 0.03-0.11; P = 0.003). In the Trendelenburg position, those distances remained unchanged (0.02 cm, 95% CI -0.01 to 0.06). Compared with end-inspiration, the SCV CSA after full expiration increased by at least 14% in both the horizontal position and the Trendelenburg position.Conclusions:The distance from the SCV to the pleura did not change after full expiration. However, this simple technique can still be considered during placement of subclavian catheters in spontaneously breathing patients, because it significantly enlarges the CSA of the SCV.
Authors:
Kyung-Jee Lim; Jung-Man Lee; Hyo-Jin Byon; Hee-Soo Kim; Chong-Sung Kim; Soo-Kyung Lee; Jin-Tae Kim
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-4
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  -     ISSN:  1526-7598     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the *Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Seoul; and.
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