Abduction of Arm Facilitates Correction of Kinked Peel-Away Sheath During Subclavian Central Line Placement

Abstract A tunneled central line catheter placement using a subclavian vein approach can be complicated by an occurrence of peel-away sheath kink which prevents the advancement of the catheter through the sheath. The kink is created due to the angular junction of subclavian and brachiocephalic veins which meet at 90 degree angle. A technique is described which corrects the peel-away sheath kink by extending the subclavian/brachiocephalic vein angle to greater than 90 degrees by abducting the patient's arm.