Malpositioning of subclavian vein catheters in left and right sided attempts: a prospective study.

The purpose of the study performed between 1987 and 1989 was to prospectively collect and analyse the mechanical complications, especially malpositioning in right-sided and left-sided attempts of catheterization of the infraclavicular subclavian vein. The subclavian vein was catheterized in 100 right-sided and 100 left-sided attempts. Catheterisation failed in 24 cases. The success rate on the right side was 84.7 per cent and on the left side 94.3 per cent. The rate of malpositioning in right-sided attempts (23%) was significantly higher than in left-sided attempts (4%) [p less than 0.001]. Minor and major mechanical complications, other than malpositioning, were also more frequent in right attempts (14.4%) than in left-sided attempts (5.6%) [p less than 0.05]. Malpositioning of central venous catheters may lead to serious complications including intravascular knotting, rupture of the heart and great vessels, incorrect central venous pressure readings and thrombosis due to delivery of hyperosmolar solutions. Based on our results a left-sided approach should be preferred in infraclavicular subclavian vein catheterization unless specific contra-indications exist.