of a subclavian vein catheter via a transverse approach.
The patient is in a supine position with the head neutral.
The operator should be positioned
on the same side that the catheter will be inserted.
The transducer is placed transversely on the vessel,
just inferior to the midportion of the clavicle,
with the orientation marker directed to the patient's head
at a 12 o'clock position.
The subclavian vein is seen as an anechoic circle,
just inferior and deep to the clavicle.
The transducer should be slowly moved
one to two inches laterally,
with the face of the transducer staying below the clavicle
to obtain the best view of the distal subclavian
and proximal axillary vein.
It is important to note that the lung lies
directly posterior to the vessel,
so posterior wall puncture of the vein should be avoided.
Adjust the transducer so the vein is centered
within the ultrasound image.
With the needle positioned just superior to the transducer,
slowly insert the needle
next to the center line on the transducer.
The needle will appear as a small bright dot
in the ultrasound image.
When the needle tip appears,
slide the transducer a short distance medially
until the needle is no longer visible.
Once again, advance the needle slowly
until it is visible in the ultrasound image.
Repeat the process to ensure that the needle tip
is advanced under direct ultrasound guidance.
Continue advancing the needle until the tip
is seen to indent and then puncture the vein.
Confirm that the needle tip lies
in the midportion of the vein by rotating the probe
90 degrees to get an in-plane longitudinal view
of the needle within the subclavian proximal axillary vein.
Guide pratique : Pose d'un cathéter central sous-clavier sous guidage échographique
Démonstration pédagogique par échographie de la mise en place d'un cathéter dans la veine sous-clavière par voie transversale. Le patient est en décubitus dorsal, la tête en position neutre. Une sonde linéaire est placée sous la clavicule afin de localiser la veine sous-clavière. L'aiguille est avancée sous guidage en temps réel, en évitant toute ponction du poumon postérieur, et sa position est confirmée dans la veine à l'aide d'une vue longitudinale.
