Right subclavian vein sonoanatomy from the supraclavicular fossa approach in children

David Santiago Giraldo Gutiérrez; Marco Antonio Bolívar Trujillo; Diego Armando Velásquez Granados; Jeiver Aldúbar Contreras Romero

doi:10.5554/22562087.e1119

David Santiago Giraldo Gutiérrez Fundación Hospital de la Misericordia. Bogotá, Colombia. https://orcid.org/0000-0002-1944-0706
Marco Antonio Bolívar Trujillo Fundación Hospital de la Misericordia. Bogotá, Colombia. https://orcid.org/0009-0007-5449-2994
Diego Armando Velásquez Granados Fundación Hospital de la Misericordia. Bogotá, Colombia. https://orcid.org/0009-0003-9147-0234
Jeiver Aldúbar Contreras Romero School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. https://orcid.org/0009-0008-6088-4289

DOI: https://doi.org/10.5554/22562087.e1119

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Abstract

Introduction: Although the subclavian vein offers significant advantages over other approaches for ultrasound-guided central venous access, it is not the first choice in the pediatric population, mainly due to its proximity to the pleura and the subclavian artery.

Objective: To assess the sonoanatomical characteristics of the subclavian vein and adjacent structures using the supraclavicular approach in a pediatric population.

Materials and Methods: Observational, intraoperative, cross-sectional study, between June 2021 and March 2022. The population consisted of ASA I, II and III children taken to non-emergent surgical procedures under general anesthesia. Images were acquired with the patients under general anesthesia, using a high-frequency linear probe to identify the subclavian vein and measure the anatomical landmarks.

Results: A total of 67 children were recruited; mean age was 6 years (IQR: 2-12 years), with male sex predominance (61%). Median weight was 22 kg (IQR: 12.2-34 Kg) and median height was 115 cm (IQR: 88-142 cm). Measurements in relation to the vessel showed a mean distance from the skin of 0.70 cm (SD: 0.18 cm), while mean distance from the skin to the pleura was 1.31 cm (SD: 0.28 cm). Mean vein diameter was 0.49 cm (IQR: 0.40-0.63 cm). The mean hypothetical approach angle to the vessel was 22.09 degrees (SD: 4.37 degrees), while the approach angle to the pleura was 39 degrees (SD: 5.31 degrees). No concurrent visualization of the vein and artery was documented in any of the recorded sonoanatomy windows. The tests pointed to an average difference of 0.61 cm in vessel depth in relation to the pleura, and the angle of approach to the vessel was 16.91 degrees smaller when compared with the angle of approach to the pleura (p < 0.001).

Conclusions: Using this technique, the supraclavicular approach to the subclavian vein in children is safe and feasible, with an average skin-to-vessel distance of 0.70 cm, minimizing the risk of pleural puncture. Additional studies are required to optimize this technique in the pediatric population.

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How to Cite

1.

Giraldo Gutiérrez DS, Bolívar Trujillo MA, Velásquez Granados DA, Contreras Romero JA. Right subclavian vein sonoanatomy from the supraclavicular fossa approach in children. Colomb. J. Anesthesiol. [Internet]. 2024 Jul. 5 [cited 2024 Jul. 27];. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1119