For better success at subclavian central venous catheter placement, have the patient turn their head 30 degrees toward the side of insertion to increase the cross sectional area of the vein.
Why does this matter?
Subclavian vein (SCV) central line placement is not exactly a risk-free procedure. Complications include pneumothorax, arterial puncture, lymphatic injury, or hemothorax. Any maneuver to make the target vessel more plump improves the chance of success and reduces the chance of sticking a needle into some other dangerous adjacent structure. Turns out, simply positioning the head can help.
A little to the right...
This was a small study using cross sectional area on ultrasound on 42 healthy volunteers, using the patient as his or her own control. The head was turned to the contralateral side, neutral position (nose straight up), or ipsilateral side. They found the cross sectional area was 0.15 cm2 greater with the head turned 30 degrees ipsilateral to the procedure versus having the head turned 30 degrees to the contralateral side. This improvement was in the supine position and was even slightly better in the Trendelenberg position. The sonographer was blinded to head position by drapes. So how much difference does this really make? Look at the picture. 0.15cm2 may not sound like much, but it is.
The Effect of Head Position on the Cross-sectional Area of the Subclavian Vein. Anesth Analg. 2017 Aug 31. doi: 10.1213/ANE.0000000000002446. [Epub ahead of print]
Peer reviewed by Thomas Davis, MD.