Normal saline flush procedure for bedside detection of misplaced subclavian vein catheter into the internal jugular vein        MA Jin-ping, WU Kai-ming, CAI Shi-rong,et al. Department of Gastrointestinal & Pancreatic Surgery，the First Affiliated Hospital，SunYat-sen University, Guangzhou 510080, China
Corresponding author: ZHAN Wen-hua, E-mail:wenhuazhan@medmail.com.cn
Abstract    Objective    To study the incidence of subclavian vein (SCV) catheter misplacement into the ipsilateral internal jugular vein (IJV) and evaluated feasibility of saline flush bedside procedure. Methods    179 gastrointestinal cancer patients underwent subclavian vein cannulation on the right side by an infraclavicular approach at First Hospital of Sun Yat-sen University from January 2008 to March 2010. After placement of subclavian vein catheter, 10 ml of normal saline was injected in the distal port of catheter, while anterior angle of ipsilateral neck was palpated by the operator or an independent observer. A thrill of fluid elicited on the palm of hand ( positive) was suggestive of misplaced catheter into ipsilateral IJV. All patients were confirmed with chest computed radiography(CR) . Results    7 patients were excluded from the study because of the unsuccessful cannulation. In nine patients（5.23%）, the catheter tip was located in the ipsilateral IJV. There were no false-positive or false-negative test results. There were 12 (6.98%) misplacements as detected by chest CR; 9 entered the IJV (5.23%) and 3 into the right atrium. (1.74%). Conclusion Normal saline flush procedure is a simple and sensitive bedside test that successfully detects misplaced SCV catheters into ipsilateral IJV.