With the widespread adoption of ultrasound-guided (USG) techniques, the traditional landmark-guided infraclavicular approach for central venous cannulation has declined in use. The subclavian vein offers distinct advantages, and there are circumstances where central venous catheter insertion into the subclavian vein (SCV) is necessary, particularly when access to the internal jugular vein is difficult. When the conventional method is challenging, alternative strategies for SCV cannulation are required. This review examines current concepts and available evidence regarding USG supraclavicular brachiocephalic vein (SC-BCV) and infraclavicular axillary vein (IC-AXV) cannulation as practical alternatives for central venous access. USG SC-BCV cannulation has several advantages, including a shorter distance to the target vein, a more direct catheter trajectory to the superior vena cava, and reduced risks of pneumothorax and arterial puncture. Comparative studies and meta-analyses demonstrate higher first-attempt success rates and lower malposition rates compared with landmark-guided IC-SCV cannulation. USG IC-AXV cannulation is also increasingly recognized as a safe and effective option, particularly useful in patients with tracheostomy, chest wall injuries, or infection risks near conventional sites. Evidence suggests that success rates are comparable to those of internal jugular vein (IJV) cannulation, with fewer infectious complications in selected patients. Both SC-BCV and IC-AXV approaches require proficiency with long-axis imaging and precise needle tracking but can be mastered with training. Accumulating evidence supports USG SC-BCV and IC-AXV cannulation as reliable alternatives to both landmark-guided IC-SCV and USG IJV approaches.
Although rubber bullets (RBs) are intended to be nonlethal, they can cause severe injuries under certain circumstances. This case report describes a rare penetrating chest injury in a 21-year-old male soldier who accidentally shot himself at close range with an RB. Upon arrival at the emergency room, computed tomography revealed lung parenchymal injury with hemorrhage and pneumothorax. An emergency thoracotomy with wedge resection was performed to remove the damaged lung tissue and foreign material, namely RB fragments. The soldier recovered and was discharged 17 days after surgery without complications. RBs are radiolucent, making it challenging to determine projectile location and trajectory from imaging alone, which can create a false sense of security regarding the severity of such injuries. Despite their nonlethal classification, RBs can cause fatal injuries; prompt surgical intervention is therefore crucial to achieving a positive outcome.
A year on from the end of coronavirus disease pandemic, there has been a resurgence in interest in international travel from South Korea. In the event of unexpected illness whilst abroad, there is a lack of information regarding the provision of medical services, repatriation, and treatment outcomes, both abroad and upon return to South Korea. A 39-year-old male experienced swelling, redness, and severe pain in his right upper arm, axilla, and anterior chest wall after undergoing intravenous cannulation in Laos. He received treatment in South Korea, 5 days after symptom onset, delayed by his travel back to South Korea. Upon diagnosis of necrotizing fasciitis emergency surgery was conducted promptly. Subsequently, he underwent multiple surgeries. The patient`s wound was closed 13 days postadmission. He was discharged on the 33rd day without complications, although continued rehabilitation was required.
Few studies have reported injuries caused by a blank cartridge shot (BCS) into the head and neck. We experienced a case of minor injury resulting from BCS (despite the close proximity). The patient was a 20-year-old male soldier who attempted suicide by firing a BCS from a K2 rifle into his mouth. He suffered from skin and soft tissue defect in the submandibular area with burns and minimal bleeding. A computed tomography scan showed subcutaneous emphysema which was suspected to be related to the projectile gas released during the firing of the BCS, and a tiny fragment without hematoma or structure injuries. We closely observed the clinical features including the occurrence of infection and functional abnormalities. The subcutaneous emphysema faded away along with the soft tissue defect. After wound management was completed on the 13th hospital day, the patient was transferred to the Department of Psychiatry without any problems.
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Penetrating chest injury caused by a rubber bullet in a Republic of Korea Army soldier: a case report Chansin Lee, Kyungwon Lee Journal of Acute Care Surgery.2025; 15(3): 164. CrossRef
Injuries from blank cartridge shots in suicide attempts within the South Korean military: a case series of five patients Jeong Il Joo, Changsin Lee, Kyungwon Lee Journal of Trauma and Injury.2024; 37(4): 262. CrossRef
One year of treating patients with open fractures of the lower extremity in a new military trauma center in Korea: a case series Ji Wool Ko, Giho Moon, Jin Geun Kwon, Kyoung Eun Kim, Hankaram Jeon, Kyungwon Lee Journal of Trauma and Injury.2023; 36(4): 376. CrossRef
Purpose Patients with coronavirus disease 2019 (COVID-19) should be isolated from others to prevent widespread infection. The purpose of this study was to evaluate the feasibility of performing peripherally inserted central catheter (PICC) placement in patients with COVID-19 isolated in the intensive care unit (ICU) of a small volume center hospital.
Methods This retrospective study included 79 patients who underwent PICC in 2 ICUs. There were 41 patients with COVID-19 who were isolated in an ICU (isolated ICU) and there were 38 patients who required ICU care who did not have COVID-19 (non-isolated ICU). Their medical records including PICC-related complications and clinical variables were compared.
Results PICC placement was performed to maintain long-term intravenous access for 78% of the COVID-19 group and 52.6% of the non-COVID-19 group (p = 0.017). The mean procedure time (minutes) was 15.2 ± 7.58 in the COVID-19 group and 12.6 ± 6.65 in the non-COVID-19 group (p = 0.109). When PICC tip locations were divided into three groups (optimal, suboptimal, and malpositioned), there was no significant difference between the two groups of patients. PICC-related complications in COVID-19 and non-COVID-19 groups included non-functioning catheter (0% vs. 5.3%, p = 0.137), occurrence of swelling or hematoma around PICC inserted site (2.4% vs. 0%, p = 0.333), and PICC-related infection.
Conclusion PICC placement for patients with COVID-19 isolated in the ICU of a small volume center hospital was feasible and safe.
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Outcomes of a bedside ultrasound-guided peripherally-inserted central catheter placement across critically-ill older patients Kyungwon Lee, Kyoung Won Yoon, Minchang Kang, Donghyoun Lee, Kiyan Heybati PLOS One.2026; 21(3): e0336966. CrossRef
Analysis of Risk Factors for Peripherally Inserted Central Venous Catheter-Associated Bloodstream Infection Sungho Lee, Kwanhoon Park, Kang Yoon Lee, Dongbeen Choi, Ji Young Jang Journal of Acute Care Surgery.2024; 14(1): 9. CrossRef
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