Central vein catheterization is an essential method in the treatment of oral and maxillofacial diseases, especially for oral cancers, because an infusion line is sometimes necessary for a long time. Among several veins, the subclavian vein is usually the first choice for catheter insertion in the field of oral and maxillofacial surgery.
Although ultrasound guidance is recommended for catheterization, it is occasionally difficult for inexperienced operators to handle ultrasound apparatus.
Our department has used an angiographic technique to catheterize into the subclavian vein. So-called "map images" were created to guide the punctate and insert location. Initially, an enhanced image of the subclavian vein was obtained through a digital subtraction angiography (DSA) technique with administration of contrast agent into the subcutaneous vein. This DSA image was overlapped on real-time fluoroscopic images to visualize the vascular distribution of the subclavian vein. Referring to these images (map images), the catheterization could be performed safely and certainly even by inexperienced operators. Moreover, if necessary, ultrasound guidance could simultaneously be used with this method.
The method using map images appeared to be a potential tool for sure catheterization into the subclavian vein.