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Size Variation Between Contralateral Infraclavicular Axillary Veins Within Individual Patients—Implications for Subclavian Venous Central Line Insertion*

Tan, Chong Oon MBBS, FANZCA, PG Dip; Weinberg, Laurence BSc, MBBCh, MRCP, FANZCA; Peyton, Philip MD, PhD, MBBS, FANZCA; Story, David BmedSci, BSc, MBBS, FANZCA, MD; McNicol, Larry MBBS, FANZCA, FRCA

doi: 10.1097/CCM.0b013e31826ab1dd
Clinical Investigations

Objective: Vein size and use of dynamic ultrasound guidance have been shown to be directly related to a reduction in insertion failure and complication rates during subclavian vein catheterization. We hypothesized that contralateral infraclavicular axillary vein sizes are significantly different within the same patient. We also aimed to demonstrate the relationship of subject’s anthropomorphic indices with vein size and contralateral vein size difference.

Design: Prospective observational study.

Setting: Operating theatre of a tertiary hospital.

Patients: Fifty adult elective and emergency surgical patients.

Interventions: The largest dimensions of each patient’s left and right infraclavicular axillary veins were measured with two-dimensional cross-sectional ultrasound examinations. The absolute difference between sides in individual patients was calculated using a paired difference t test and the relationship between hand dominance and vein size calculated by a paired difference t test of dominant side vein size minus nondominant side vein size

Measurements and Main Results: Forty-five patients (90%) of patients were right hand dominant. The mean proportional cross-sectional area difference between left and right sides in individual patients was 59.7% (SEM 9.2%), with absolute cross-sectional area difference of 26.7 mm2 (SEM 2.8 mm2). All test statistics reached statistical significance at p < 0.0001. There was no relationship between right hand dominance and ipsilateral infraclavicular axillary vein size (p = 1.0), nor was there any clinically significant correlation between subject’s anthropomorphic indices and ipsilateral infraclavicular axillary vein size or contralateral vein size difference (largest Pearson’s r = 0.22).

Conclusions: Contralateral infraclavicular axillary vein sizes within the same patient are significantly different in the adult surgical population and bear no clear relation to patient hand dominance. The magnitude of contralateral difference or absolute ipsilateral infraclavicular axillary vein size cannot be predicted by a subject’s anthropomorphic indices. All patients in whom subclavian central line insertion is planned should have both sides examined by ultrasound to determine which side has the largest vessel.

All authors: Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia.

*See also p. 669.

The authors have not disclosed any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins