Open Access
Effect of shoulder positioning on ultrasonic visualisation of the subclavian vein in healthy adults: A prospective observational study
Author(s) -
Leung Hei Jim,
Wong Lok Yu,
Pak Chi Shing,
Li Chuan Marc Yang
Publication year - 2023
Publication title -
hong kong journal of emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.145
H-Index - 12
eISSN - 2309-5407
pISSN - 1024-9079
DOI - 10.1177/10249079211000969
Subject(s) - medicine , subclavian vein , ultrasound , prospective cohort study , radiology , surgery , catheter
Introduction: Ultrasound guidance is commonly used during central venous cannulation. Subclavian vein is a commonly chosen site, but previous studies found varying results in the ideal positioning of the shoulder for subclavian vein cannulation. The objective of this study is to determine which shoulder position results in the greatest cross‐sectional area of the right subclavian vein for cannulation. Methods: In this prospective observational study, ultrasound was performed on healthy adult volunteers to visualise the right subclavian vein in three different shoulder positions: neutral, abduction and retraction. A blinded independent investigator measured the cross‐sectional areas by computer software using planimetry method. Statistical analysis was performed by one‐way repeated measures analysis of variance. Results: Forty‐four adults participated in the study. The mean cross‐sectional area of the right subclavian vein in shoulder neutral, abduction and retraction positions were 1.05 ± 0.33 cm 2 , 1.01 ± 0.31 cm 2 and 0.82 ± 0.28 cm 2 , respectively. When compared to shoulder retraction, the cross‐sectional areas were significantly increased in shoulder neutral ( P < 0.01) and abduction ( P < 0.01) positions. There was no significant difference between shoulder neutral and abduction position ( P = 0.71). Conclusion: Positioning the shoulder in neutral or abduction results in the greatest cross‐sectional area of the right subclavian vein and may be more ideal for ultrasound guided cannulation.