Comparison of the neutral and retracted shoulder positions for infraclavicular subclavian venous catheterization: a randomized, non-inferiority trial

There are controversies regarding the most efficient shoulder position during infraclavicular subclavian venous catheterization. We hypothesized that, regarding the success rate of subclavian venous catheterization, the neutral shoulder position would not be inferior to the retracted shoulder positi...

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Bibliographic Details
Published in:British journal of anaesthesia : BJA 2013-08, Vol.111 (2), p.191-196
Main Authors: Kim, H.J., Jung, S.H., Min, J, Hong, D.M., Jeon, Y, Bahk, J.-H.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
catheterization, central venous
Catheterization, Central Venous - adverse effects
Catheterization, Central Venous - methods
Female
Hemothorax - etiology
Humans
Male
Middle Aged
Patient Positioning - methods
Pneumothorax - etiology
Prospective Studies
Punctures - adverse effects
Shoulder
Subclavian Vein
Young Adult
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Summary:There are controversies regarding the most efficient shoulder position during infraclavicular subclavian venous catheterization. We hypothesized that, regarding the success rate of subclavian venous catheterization, the neutral shoulder position would not be inferior to the retracted shoulder position. A total of 362 patients who underwent elective surgery were randomly assigned to two groups: those who underwent subclavian venous catheterizations in the neutral shoulder position (neutral group, n=181) or in the retracted shoulder position (retracted group, n=181). In the retracted group, a 1 litre saline bag was placed longitudinally beneath the spinal column between the scapulae to allow the shoulders to fall into a ‘retracted’ position. The incidence of failures to place the central venous catheters and complications such as arterial puncture, pneumothorax, or haemothorax were recorded. The success rates were 95.6% (173/181) in the neutral group and 96.1% (174/181) in the retracted group. The difference of 0.5% was within the prespecified non-inferiority margin of 5% with a P-value of 0.017 [two-sided 95% confidence interval (CI), −0.036 to 0.047; upper limit of the 95% CI, 0.040]. There were four catheterization failures (2.2%) in the neutral group and two failures (1.1%) in the retracted group. Complication rates were not significantly different between the neutral and retracted groups [3/181 (1.7%) vs 4/181 (2.2%) for arterial punctures and 1/181 (0.6%) vs 1/181 (0.6%) for pneumothorax]. The neutral shoulder position was as effective as the retracted shoulder position for infraclavicular subclavian venous catheterization. Shoulder retraction does not appear to be necessary for the infraclavicular subclavian venous catheterization. ClinicalTrials.gov, NCT01368692.
ISSN:0007-0912
1471-6771
DOI:10.1093/bja/aet026