To the Editor.—Thank you for the elegant article by Jesseph et al1 regarding "Patient Positioning for Subclavian Vein Catheterization." Because this procedure is most often performed by residents-in-training, I would like to mention that some of the maneuvers traditionally recommended during subclavian vein catheterization do not have much to do with the locoregional anatomy.
I disagree with the conclusion that Trendelenburg positioning is probably unnecessary. One of the major risks during this procedure is air embolism, and by increasing the venous pressure, the Trendelenburg position can decrease the incidence of this potentially fatal complication. Another point worth mentioning concerns malpositioning of the tip of the catheter in the internal jugular vein. The incidence of this situation "may be minimized by turning the patient's head to the ipsilateral side during cannula advancement,"2 not to the contralateral side as mentioned in the article by Jesseph et al.
COUTO J. Subclavian Vein Catheterization. Arch Surg. 1988;123(4):523. doi:10.1001/archsurg.1988.01400280137029