A Supraclavicular Fossa Ultrasound Window for Central Venous Catheter Positioning

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We read with interest the study by Bowdle et al1 on ultrasound identification of the guidewire in the brachiocephalic vein (BCV) for the prevention of inadvertent arterial catheterization during internal jugular central venous catheter (CVC) placement. It should be pointed out that the described approach does not only allow visualization of the guidewire in the BCV but enables the operator to advance the tip of the guidewire precisely to the cavoatrial junction. Previously, we have reported that a right supraclavicular fossa ultrasound view is feasible to position a CVC tip in real time.2 This ultrasound window provides a full view of the BCV, the superior vena cava (SVC), and the right pulmonary artery crossing the distal SVC at the cavoatrial junction, which represents the ultrasound landmark for real-time CVC tip positioning. A microconvex probe was used for puncture of the right internal jugular vein and the right subclavian vein, respectively, and advancing of the guidewire via the right BCV and SVC to the cavoatrial junction.3 We recommend the supraclavicular fossa view for real-time ultrasound-guided CVC tip positioning to exclude arterial puncture, correct mispositioned guidewires immediately, verify the CVC tip in the cavoatrial junction, and omit the chest radiograph confirmation.

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