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

Background. Catheter tip malposition is commonly observed during subclavian vein catheterization. This study was to investigate whether position and partially retracted the guide wire could reduce catheter malposition. Methods. The children needing right subclavian venipuncture catheterization were randomly divided into two groups: test group A (82 patients) and control group B (82 patients). In group A, catheterization was performed with the patient in a supine position and the guide wire partially retracted during placement. In contrast, in group B, catheterization was done with the patient in Trendelenburg without partial retraction of the guide wire. The catheter tip direction was examined using intraoperative ultrasound, and a postoperative chest X-ray was obtained. Results. The rate of correct catheter tip direction at first insertion was higher in group A compared to group B (86.2% vs. 66.7%, P < 0.05). There were no significant differences in incidence and general data between the two groups. The repeated vascular puncture was unsuccessful in three patients (2 cases in group A and 1 case in group B), and right internal jugular vein catheter instead. Conclusions. The guide wire can be partially retracted in the supine position to reduce catheter tip malposition during right subclavian venipuncture in children.