TY - JOUR
T1 - Obesity hinders ultrasound visualization of the subclavian vein
T2 - Implications for central venous access
AU - McGrath, Todd M.
AU - Farabaugh, Eric A.
AU - Pickett, Michael J.
AU - Wagner, David K.
AU - Griswold-Theodorson, Sharon
PY - 2012
Y1 - 2012
N2 - Purpose: International policy statements from the US and the UK recommend real-time ultrasound guidance (USG) for placement of central venous catheters (CVCs) to improve patient safety. The evidence to support USG for the internal jugular (IJ) route is unequivocal; however, there is conflicting data on the effectiveness of USG in visualization of the subclavian vein (SCV). This study sought to determine whether body mass index (BMI) or clavicle shape affected SCV visualization with USG. Methods: Forty-one emergency department patients were enrolled. Subject height and weight were recorded for BMI calculation. The clavicle shape was recorded as either flat or protuberant. USG was performed to identify the SCV vein in both the transverse and sagittal views. The ability to visualize the vein was rated on a three point rubric scale. Results: One subject had an underweight BMI, 18 a normal BMI, 12 an overweight BMI, and 10 an obese BMI. The improvement in the odds ratio (OR) of the ability to see the SCV in subjects with a normal compared to overweight/obese BMI was statistically significant (transverse view unadjusted OR=18.0 (95% CI 3.21 - 100.94), P=.001 and adjusted for a flat clavicle OR=10.54 (95% CI 1.41 - 78.37), P=.021). Conclusions: Higher BMI and the presence of a flat clavicle limit the ability to visualize the SCV. These findings may help account for why USG for placement of SCV CVCs is less utilized. However, patients with a low/normal BMI and protuberant clavicle may benefit from USG when attempting SCV CVCs.
AB - Purpose: International policy statements from the US and the UK recommend real-time ultrasound guidance (USG) for placement of central venous catheters (CVCs) to improve patient safety. The evidence to support USG for the internal jugular (IJ) route is unequivocal; however, there is conflicting data on the effectiveness of USG in visualization of the subclavian vein (SCV). This study sought to determine whether body mass index (BMI) or clavicle shape affected SCV visualization with USG. Methods: Forty-one emergency department patients were enrolled. Subject height and weight were recorded for BMI calculation. The clavicle shape was recorded as either flat or protuberant. USG was performed to identify the SCV vein in both the transverse and sagittal views. The ability to visualize the vein was rated on a three point rubric scale. Results: One subject had an underweight BMI, 18 a normal BMI, 12 an overweight BMI, and 10 an obese BMI. The improvement in the odds ratio (OR) of the ability to see the SCV in subjects with a normal compared to overweight/obese BMI was statistically significant (transverse view unadjusted OR=18.0 (95% CI 3.21 - 100.94), P=.001 and adjusted for a flat clavicle OR=10.54 (95% CI 1.41 - 78.37), P=.021). Conclusions: Higher BMI and the presence of a flat clavicle limit the ability to visualize the SCV. These findings may help account for why USG for placement of SCV CVCs is less utilized. However, patients with a low/normal BMI and protuberant clavicle may benefit from USG when attempting SCV CVCs.
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U2 - 10.5301/jva.5000051
DO - 10.5301/jva.5000051
M3 - Article
C2 - 22266587
AN - SCOPUS:84866731367
SN - 1129-7298
VL - 13
SP - 246
EP - 250
JO - Journal of Vascular Access
JF - Journal of Vascular Access
IS - 2
ER -