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August 30, 2026Indian Journal of NephrologyOpen Access

Ipsilateral Arm Abduction to Facilitate Subclavian Tunneled Cuffed Catheter (TCC) Placement

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Authors

NVNishanth ViswanathanSSSanthakumar SenthilvelanSSSabarinath Shanmugam

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Overview

Case series reveals arm abduction straightens venous pathways during subclavian catheter placement in kidney disease, highlighting a simple positional technique to prevent sheath kinking.

Key Points

  • To evaluate the utility of 90-degree ipsilateral arm abduction in preventing peel-apart sheath kinking during subclavian tunneled cuffed catheter placement.
  • Reviewed three cases of subclavian tunneled cuffed catheter (TCC) placement in patients with chronic kidney disease who had exhausted standard internal jugular and femoral access routes.
  • Compared procedural outcomes between conventional neutral (adducted) arm positioning (Case 1) and 90-degree ipsilateral arm abduction (Cases 2 and 3).
  • Catheter placement in the adducted position (Case 1) resulted in severe peel-apart sheath kinking and resistance due to acute angulation between the subclavian and brachiocephalic veins.
  • Ipsilateral 90-degree arm abduction in Cases 2 and 3 successfully straightened the venous pathway, eliminating sheath kinking and facilitating smooth catheter insertion, with Case 2 also successfully incorporating balloon venoplasty for pre-existing stenosis.

Cite This Study

Viswanathan et al. (2026) studied this question.

synapsesocial.com/papers/6a93f1626c1a8fb52e79e3e0https://doi.org/10.25259/ijn_256_2026
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