Central venous catheter misplacement is common (approximately 7%) after right subclavian vein catheterisation. To avoid it, ultrasound-guided tip navigation may be used during the catheterisation procedure to help direct the guidewire towards the lower superior vena cava. We aimed to determine the number of central venous catheter misplacements when using the right supraclavicular fossa ultrasound view to aid guidewire positioning in right infraclavicular subclavian vein catheterisation. We hypothesised that the incidence of catheter misplacements could be reduced to 1% when using this ultrasound technique. One -hundred and three adult patients were prospectively included. After vein puncture and guidewire insertion, we used the right supraclavicular fossa ultrasound view to confirm correct guidewire J-tip position in the lower superior vena cava and corrected the position of misplaced guidewires using real-time ultrasound guidance. Successful catheterisation of the right subclavian vein was achieved in all patients. The guidewire J-tip was initially misplaced in 15 patients, either in the ipsilateral internal jugular vein (n = 8) or in the left brachiocephalic vein (n = 7). In 12 patients it was possible to adjust the guidewire J-tip to a correct position in the lower superior vena cava. All ultrasound-determined final guidewire J-tip positions were consistent with the central venous catheter tip positions on chest X-ray. Three out of 103 catheters were misplaced, corresponding to an incidence (95%CI) of 2.9 (0.6–8.3) %. Although the hypothesis could not be confirmed, this study demonstrated the usefulness of the right supraclavicular fossa ultrasound view for real-time confirmation and correction of the guidewire position in right infraclavicular subclavian vein catheterisation.

中文翻译：

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右锁骨下静脉置管中正确导管尖端定位的右锁骨上窝超声视图：一项前瞻性观察研究

右锁骨下静脉置管后中心静脉导管错位很常见（约 7%）。为避免这种情况，可在导管插入手术期间使用超声引导的尖端导航，以帮助将导丝引导至下上腔静脉。我们的目的是确定使用右锁骨上窝超声切面辅助在右锁骨下锁骨下静脉置管中定位导丝时中心静脉导管错位的次数。我们假设使用这种超声技术时导管错位的发生率可以降低到 1%。一百零三名成年患者被前瞻性地包括在内。静脉穿刺和导丝插入后，我们使用右锁骨上窝超声视图来确认下上腔静脉中正确的导丝 J 尖端位置，并使用实时超声引导校正错位的导丝的位置。所有患者均成功插入右锁骨下静脉。15 名患者的 J 型导丝最初错位，位于同侧颈内静脉 (n = 8) 或左侧头臂静脉 (n = 7)。在 12 名患者中，可以将导丝 J-tip 调整到下上腔静脉的正确位置。所有超声确定的最终导丝 J 尖端位置与胸部 X 射线上的中心静脉导管尖端位置一致。103 根导管中有 3 根被放错了位置，对应的发生率 (95% CI) 为 2.9 (0.6–8.3) %。