Humberto Lugo-Vicente MD FACS FAAP

18/04/2026

Our most recent scientific article:

Trinidad-Pineiro J, Lugo H, Dávila P, et al. (April 16, 2026) Pediatric Ogilvie Syndrome Following Laparoscopic Appendectomy: A Case Report and Literature Review . Cureus 18(4): e107181. doi:10.7759/cureus.107181

Acute colonic pseudo-obstruction (ACPO), or Ogilvie syndrome, is a rare cause of massive colonic dilation in children, occurring without mechanical obstruction. Its subtle presentation often mimics ileus or bowel obstruction, which may delay diagnosis and increase the risk of ischemia or perforation...

16/04/2026

Splenoportal Thrombosis After Splenectomy

Splenoportal thrombosis represents one of the most important vascular complications following splenectomy, emerging at the intersection of surgical physiology, hematologic adaptation, and altered portal venous hemodynamics. Although splenectomy remains a highly effective therapeutic intervention for hematologic disease, portal hypertension, trauma, and selected oncologic conditions, removal of the spleen initiates profound systemic and regional circulatory changes that predispose patients to thrombosis within the splenic, portal, and mesenteric venous systems. The growing body of contemporary literature has clarified that this complication is neither rare nor incidental but rather a predictable biological consequence that demands structured prevention, early recognition, and individualized management.

The incidence of splenoportal thrombosis after splenectomy varies widely across clinical populations, reflecting differences in underlying disease, surgical indication, and surveillance strategies. Reported rates generally fall between approximately 5% and more than 20%, with higher values observed when routine postoperative imaging is performed rather than symptom-driven investigation. Some analyses suggest even broader ranges in high-risk populations, particularly those with portal hypertension or cirrhosis, underscoring that the true incidence may historically have been underestimated due to asymptomatic cases remaining undetected.

Clinically, splenoportal thrombosis encompasses thrombosis involving the splenic vein, portal vein, superior mesenteric vein, or combinations of these vessels. The condition may present subtly, with abdominal pain, fever, nausea, or nonspecific malaise, but can progress to severe complications including intestinal ischemia, portal hypertension exacerbation, or hepatic dysfunction if untreated. Importantly, many patients remain asymptomatic during early stages, making imaging surveillance a critical component of postoperative care in selected populations.

The pathophysiology of thrombosis after splenectomy is multifactorial and best understood through Virchow's triad: hypercoagulability, endothelial injury, and venous stasis. Splenectomy induces an immediate hematologic shift characterized by increased circulating platelets and procoagulant factors. Postoperative thrombocytosis occurs in a majority of patients and may reach extreme levels, although the direct relationship between platelet elevation and thrombosis remains complex. Some investigations demonstrate that elevated platelet counts correlate with thrombotic risk and may serve as predictive thresholds, while others suggest thrombosis occurs independently of thrombocytosis alone, indicating that platelet number is only one component of a broader prothrombotic environment.

Beyond hematologic alterations, splenectomy dramatically modifies portal venous flow dynamics. Removal of the spleen eliminates a major inflow contributor to the portal system, producing abrupt changes in velocity patterns, pressure gradients, and wall shear stress. Computational modeling studies have demonstrated that areas of low wall shear stress increase after splenic vein ligation, creating localized hemodynamic environments conducive to clot formation. These changes are influenced by anatomical variables such as splenic vein diameter and portal venous geometry, suggesting that patient-specific vascular architecture plays a central role in thrombosis susceptibility.

Surgical factors further modulate risk. Longer operative times, greater tissue manipulation, and technical complexity appear associated with higher thrombotic incidence, likely reflecting both inflammatory activation and prolonged venous stasis. Massive splenomegaly has emerged as one of the strongest predictors, particularly when specimen weight exceeds one kilogram. Large spleens are associated with increased venous caliber and altered postoperative flow redistribution, amplifying stasis within the portal circulation. Hematologic disorders such as myeloproliferative disease and myelofibrosis also confer elevated risk, combining intrinsic hypercoagulability with anatomical changes.

Interestingly, the surgical approach itself—open versus laparoscopic—does not appear to independently determine thrombosis rates. While minimally invasive splenectomy offers reduced postoperative morbidity and shorter hospitalization, venous thrombotic incidence remains comparable between approaches. This observation reinforces the concept that thrombosis arises primarily from physiological consequences of splenic removal rather than technical modality. Temporal patterns of thrombosis formation provide additional insight. Most events occur within the first two to three postoperative weeks, although risk may persist for months. This delayed vulnerability highlights a critical limitation of traditional in-hospital prophylaxis strategies that terminate anticoagulation at discharge. Evidence increasingly suggests that extended thromboprophylaxis significantly reduces thrombotic events without substantially increasing bleeding complications. Patients receiving anticoagulation beyond hospitalization demonstrate markedly lower thrombosis rates compared with those treated only perioperatively.

The role of anticoagulation has therefore become central in preventive strategies. Analyses evaluating postoperative anticoagulant therapy indicate that low–molecular weight heparin followed by oral anticoagulation can substantially decrease portal venous thrombosis incidence, particularly during the first six postoperative months. Importantly, concerns regarding excessive bleeding risk have not been consistently supported by clinical outcomes, suggesting that carefully selected prophylactic regimens are both effective and safe.

Despite these advances, universal anticoagulation remains controversial. Not all patients carry equal risk, and indiscriminate therapy may expose low-risk individuals to unnecessary complications. Consequently, recent research has focused on risk prediction models designed to identify patients most likely to develop thrombosis. These models integrate clinical, laboratory, and anatomical variables, achieving moderate predictive accuracy with discrimination values generally indicating reliable but imperfect performance. While promising, many models suffer from limited external validation and retrospective design, emphasizing the need for individualized clinical judgment rather than reliance on algorithms alone.

Emerging predictive approaches extend beyond clinical scoring systems into computational hemodynamics. Patient-specific modeling of portal venous circulation allows simulation of postoperative flow conditions, enabling identification of regions predisposed to thrombosis before surgery occurs. Such techniques represent a potential paradigm shift, moving prevention from reactive monitoring toward personalized preoperative risk stratification. Although still investigational, these tools highlight the growing convergence of surgery, imaging, and computational medicine in perioperative risk assessment.

Diagnosis of splenoportal thrombosis relies primarily on imaging modalities. Contrast-enhanced computed tomography remains the most commonly used diagnostic tool, offering high sensitivity and anatomical detail, while Doppler ultrasonography provides a noninvasive alternative suitable for screening and follow-up. Given the frequency of asymptomatic presentation, routine imaging protocols have been advocated for high-risk patients, particularly during the early postoperative period when intervention is most effective.

Management strategies are generally successful when thrombosis is detected early. Anticoagulation alone leads to recanalization or complete resolution in most patients, with low recurrence rates reported during long-term follow-up. Severe complications are uncommon when treatment is initiated promptly, reinforcing the importance of vigilance rather than aggressive intervention. Surgical or interventional radiologic procedures are rarely required and are typically reserved for cases complicated by bowel ischemia or extensive thrombosis.

From a broader perspective, splenoportal thrombosis illustrates how removal of a single organ can disrupt systemic equilibrium. The spleen functions not only as an immunologic and hematologic organ but also as a regulator of portal circulation. Its absence transforms vascular dynamics, coagulation balance, and endothelial biology simultaneously. The postoperative state therefore represents a transitional physiological condition rather than a simple recovery phase, demanding targeted monitoring and adaptive management.

Future directions in the field increasingly emphasize personalization. Integration of platelet kinetics, spleen size, disease etiology, operative characteristics, and hemodynamic modeling may eventually permit individualized prophylaxis protocols tailored to each patient's risk profile. Advances in imaging analytics and machine learning may further refine prediction accuracy, allowing clinicians to intervene selectively while minimizing overtreatment.

In summary, splenoportal thrombosis after splenectomy is a common and clinically significant complication driven by complex interactions between hypercoagulability, altered venous flow, and patient-specific anatomical factors. Although often silent initially, it carries potential for severe morbidity if unrecognized. Contemporary evidence supports extended thromboprophylaxis in selected patients, early imaging surveillance, and prompt anticoagulation upon diagnosis. The evolution of predictive models and computational hemodynamic analysis signals a transition toward precision perioperative care. As understanding of postoperative portal physiology continues to expand, prevention and management strategies are likely to become increasingly individualized, improving outcomes while preserving the therapeutic benefits of splenectomy.

Ultimately, recognition of splenoportal thrombosis as an expected physiological risk rather than an unpredictable complication represents the most important conceptual advance. Through systematic risk assessment, vigilant monitoring, and tailored prophylaxis, the complication can be anticipated, detected early, and treated effectively, transforming a once underappreciated hazard into a manageable aspect of modern splenic surgery.

References:
1- Rottenstreich A, Kleinstern G, Spectre G, Da'as N, Ziv E, Kalish Y: Thromboembolic Events Following Splenectomy: Risk Factors, Prevention, Management and Outcomes. World J Surg. 42(3):675-681, 2018
2- Szasz P, Ardestani A, Shoji BT, Brooks DC, Tavakkoli A: Predicting venous thrombosis in patients undergoing elective splenectomy. Surg Endosc. 34(5):2191-2196, 2020
3- Swinson B, Waters PS, Webber L, Nathanson L, Cavallucci DJ, O'Rourke N, Bryant RD: Portal vein thrombosis following elective laparoscopic splenectomy: incidence and analysis of risk factors. Surg Endosc. 36(5):3332-3339, 2022
4- Liao Z, Wang Z, Su C, Pei Y, Li W, Liu J: Long term prophylactic anticoagulation for portal vein thrombosis after splenectomy: A systematic review and meta-analysis. PLoS One. 18(8):e0290164, 2023
5- Wang T, Yong Y, Ge X, Wang J: A computational model-based study on the feasibility of predicting post-splenectomy thrombosis using hemodynamic metrics. Front Bioeng Biotechnol. 11:1276999, 2024
6- Huang L, Han Y, Li Y, Li J: Risk prediction models for portal vein thrombosis (PVT) in patients after splenectomy: A systematic review and meta-analysis. Eur J Surg Oncol. 51(10):110300, 2025

16/04/2026

Language Concordant Clinic

Modern health care unfolds in an increasingly multilingual world. Millions of patients seek medical attention in settings where the language of care differs from the language in which they think, feel, and make sense of illness. This linguistic mismatch is not a peripheral inconvenience; it is a structural determinant of health. Language-concordant clinics emerge from this reality not merely as a service innovation, but as a reframing of communication itself as a core clinical intervention.

Language-concordant care occurs when patients and clinicians share a common language and are able to communicate directly, fluently, and comfortably throughout the clinical encounter. In language-concordant clinics, this principle is embedded at the organizational level: appointments, workflows, educational materials, and clinical interactions are intentionally designed to occur in the patient's preferred language. This model goes beyond episodic interpretation and establishes linguistic alignment as a foundational element of care delivery.

The clinical consequences of language discordance are well documented. When communication is filtered through language barriers, patients experience diminished understanding of diagnoses, reduced participation in decision-making, lower satisfaction, and increased vulnerability during critical moments such as consent, discharge, and treatment planning. These effects are not limited to subjective experience. Language discordance has been associated with higher rates of medical errors, longer hospital stays, delayed care, and poorer control of chronic disease. In this context, language is not simply a vehicle for information exchange; it shapes trust, safety, and clinical outcomes.

Trust occupies a central position in the therapeutic relationship, and language is one of its most powerful determinants. Trust requires honesty, clarity, and the ability to express concerns, fears, and values without hesitation. When patients must rely on intermediaries to communicate intimate or complex information, trust becomes fragile. Even when professional interpreters are used appropriately, the presence of a third party can alter conversational flow, limit spontaneity, and subtly constrain disclosure. Language-concordant encounters, by contrast, allow patients to speak in their own voice and clinicians to respond with nuance, empathy, and immediacy. This directness fosters a sense of being heard and respected, which in turn strengthens engagement and adherence.

Language-concordant clinics do not dismiss the essential role of professional interpreters. Interpreters remain critical for ensuring access, equity, and legal compliance, particularly when language-concordant clinicians are unavailable. However, evidence consistently shows that interpreter-mediated encounters, while superior to ad hoc or absent interpretation, do not fully replicate the relational depth of direct communication. Patients in language-concordant settings are more likely to ask questions, clarify uncertainties, and actively participate in their care. This increased engagement is especially evident in pediatric and family-centered contexts, where caregivers must understand and consent to complex interventions on behalf of others.

Informed consent represents one of the most ethically sensitive domains in medicine, and language discordance poses persistent risks to its integrity. Consent requires not only the transmission of information but the assurance that information is understood. When consent discussions occur in a non-preferred language or through inconsistent interpretation, comprehension may be partial, documentation incomplete, and patient autonomy compromised. Language-concordant clinics reduce these risks by aligning the consent process with the patient's linguistic reality, thereby reinforcing both ethical standards and patient safety.

The benefits of language-concordant care extend beyond individual encounters to system-level outcomes. Clinics that operate in a shared language often demonstrate improved efficiency, fewer misunderstandings, and smoother clinical workflows. Time that might otherwise be spent clarifying miscommunication or correcting errors is redirected toward meaningful clinical engagement. In emergency and inpatient settings, professional interpretation modalities—particularly video-based options—have demonstrated improvements in comprehension and satisfaction, yet even these modalities are often underutilized due to workflow barriers and cultural habits. Language-concordant clinics bypass many of these obstacles by embedding communication fluency directly into care delivery.

Importantly, language-concordant clinics also serve as a lens through which broader social determinants of health become visible. Language is intertwined with migration history, educational opportunity, socioeconomic status, and exposure to trauma. Patients who prefer non-dominant languages often navigate health systems shaped by structural inequities that extend far beyond communication. When care is delivered in a shared language, clinicians gain deeper insight into patients' lived experiences, belief systems, and contextual challenges. This understanding enables more culturally responsive care and more realistic treatment planning.

The educational implications of language-concordant clinics are profound. As health systems become more linguistically diverse, the preparation of clinicians must evolve accordingly. Linguistic competence cannot be treated as an informal skill acquired incidentally or self-declared without assessment. Safe language-concordant care requires rigorous training, standardized evaluation, and clear institutional policies defining when clinicians are qualified to practice in a non-dominant language. Without these safeguards, well-intentioned efforts risk introducing new forms of error and inequity.

Technology offers emerging opportunities to support language-concordant care, particularly in settings where bilingual clinicians are scarce. Digital interpretation platforms, video-based services, and AI-assisted translation tools have demonstrated potential to expand access and reduce delays. However, these tools must be implemented thoughtfully. Technology can enhance communication, but it cannot substitute for linguistic competence, cultural humility, or relational trust. Moreover, AI-generated translations require careful oversight to ensure accuracy, contextual appropriateness, and patient safety. In language-concordant clinics, technology functions best as an adjunct rather than a replacement for human connection.

The implementation of language-concordant clinics requires institutional commitment. Scheduling systems must align patients with linguistically appropriate providers. Educational materials must be available in relevant languages. Clinical teams must be trained to recognize language preference not as a binary attribute but as a spectrum shaped by context, stress, and health literacy. Quality improvement initiatives should track language alignment as a measurable dimension of care quality, alongside traditional clinical metrics.

Critically, language-concordant clinics challenge the assumption that interpretation alone is sufficient to achieve equity. While interpretation is indispensable, equity demands more than access; it demands resonance. Resonance occurs when patients recognize themselves in the language of care, when their concerns are not translated but expressed directly, and when clinicians listen without filters. Language-concordant clinics institutionalize this resonance.

From a policy perspective, language-concordant clinics represent an investment in prevention. By reducing misunderstandings, enhancing adherence, and strengthening trust, these clinics mitigate downstream costs associated with complications, readmissions, and disengagement from care. They also signal respect for linguistic diversity as an asset rather than a barrier, reframing multilingualism as a clinical resource.

Ultimately, language-concordant clinics reaffirm a fundamental truth: medicine begins not with technology or protocol, but with human interaction. Every diagnosis, every decision, and every act of healing is negotiated through language. When that language is shared, care becomes not only more effective, but more humane. Language-concordant clinics do not merely translate medicine; they restore its voice.

References:
1- Molina RL, Kasper J: The power of language-concordant care: a call to action for medical schools. BMC Medical Education. 19(1):378, 2019
2- Boylen S, Cherian S, Gill FJ, Leslie GD, Wilson S: Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI Evidence Synthesis. 18(7):1360–1388, 2020
3- Daggett A, Abdollahi S, Hashemzadeh M: The effect of language concordance on health care relationship trust score. Cureus. 15(5):e39530, 2023
4- Sharfuddin N, Mathura P, Mac A, Ling E, Tan M, Khatib E, Suranyi Y, Kassam N: Advancing language concordant care: a multimodal medical interpretation intervention. BMJ Open Quality. 13(1):e002511, 2024
5- Dzuali F, Seiger K, Novoa R, Aleshin M, Teng J, Lester J, Daneshjou R: ChatGPT may improve access to language-concordant care for patients with non–English language preferences. JMIR Medical Education. 10:e51435, 2024

16/04/2026

US-Guided Subclavian Cannulation

Central venous access remains a cornerstone of modern critical care, anesthesiology, emergency medicine, pediatrics, and long-term infusion therapy. Among available access sites, the subclavian venous system has historically been favored because of lower infection rates, improved patient comfort, and reliable catheter stability. However, traditional landmark-based subclavian cannulation has long been associated with concerns about mechanical complications, particularly pneumothorax and arterial injury. The integration of real-time ultrasound guidance has fundamentally altered this risk-benefit balance, enabling safer visualization, higher success rates, and renewed clinical interest in subclavian access.

Ultrasound-guided subclavian cannulation represents not merely a technical modification of an older procedure, but a conceptual shift in how clinicians approach central venous access. By transforming a "blind" technique into a visual, anatomy-driven intervention, ultrasound allows dynamic assessment of vascular patency, anatomic variation, and needle trajectory. This evolution is particularly relevant in patients with altered anatomy, prior catheterization, coagulopathy, hypovolemia, or in populations such as neonates and children where margins for error are narrow.

A fundamental advantage of ultrasound guidance lies in its ability to identify individual anatomic variability. The subclavian vein may differ substantially in depth, diameter, and spatial relationship to the artery, pleura, and clavicle. Landmark techniques cannot reliably account for these variations, whereas ultrasound permits direct visualization before and during needle advancement. Preprocedural scanning allows confirmation of venous patency, exclusion of thrombosis, and selection of the safest puncture site, while real-time imaging enables continuous monitoring of needle position relative to critical structures.

Modern ultrasound-guided subclavian cannulation is most commonly performed using either an infraclavicular or supraclavicular approach. In the infraclavicular technique, the vein is visualized laterally where it anatomically corresponds to the proximal axillary vein, a location that offers improved ultrasound windows and increased distance from the pleural dome. This distinction is clinically important: while the term "subclavian cannulation" remains widely used, the actual puncture site in many ultrasound-guided approaches is anatomically axillary, a clarification that has implications for procedural standardization, safety comparisons, and educational accuracy. Failure to recognize this distinction may obscure meaningful differences between techniques and complicate interpretation of outcomes .

From a technical standpoint, ultrasound guidance can be applied using short-axis (out-of-plane), long-axis (in-plane), or oblique approaches. Each method carries distinct advantages. Short-axis views provide excellent visualization of surrounding anatomy and are often easier for less experienced operators, while long-axis views allow continuous visualization of the needle shaft and tip, reducing the risk of posterior wall pe*******on. The oblique approach seeks to combine the benefits of both, though it requires greater operator experience. Current evidence does not conclusively favor one approach over another, underscoring the importance of operator familiarity and consistent training rather than rigid technique selection.

Accumulating clinical data demonstrate that ultrasound-guided subclavian cannulation improves procedural safety compared with landmark techniques. Reductions in arterial puncture, hematoma formation, and pneumothorax have been consistently observed, particularly when real-time guidance is employed. While the magnitude of benefit may be smaller than that seen with internal jugular access, the absolute reduction in serious complications is clinically meaningful, especially given the advantages of subclavian catheter placement for long-term use. Importantly, success rates with ultrasound guidance approach those achieved with jugular access, challenging the perception that the subclavian route is inherently more difficult or dangerous .

One of the most compelling expansions of ultrasound-guided subclavian cannulation has occurred in neonatal and pediatric care. In low birth weight and very low birth weight infants, central venous access is often required when umbilical or peripheral routes are unavailable or inadequate. Ultrasound-guided supraclavicular subclavian cannulation has demonstrated high success rates even in infants weighing less than 1,500 grams, with remarkably low complication profiles. Visualization of the vein, pleura, and adjacent structures allows precise needle control in patients for whom landmark-based techniques would be prohibitively risky. These findings reinforce the role of ultrasound not only as a safety adjunct, but as an enabler of access strategies previously considered impractical in fragile populations .

Ultrasound guidance also expands available options when conventional access sites are exhausted. In patients with venous thrombosis, stenosis, or prior catheter-related injury, alternative routes such as the supraclavicular approach to the brachiocephalic vein can be employed under direct visualization. This adaptability is particularly valuable for tunneled catheters and long-term devices, where preservation of remaining venous access is critical. Real-time ultrasound allows these alternative approaches to be executed with precision, minimizing repeated failed attempts and associated complications .

Comparative evidence has further highlighted the role of ultrasound-guided axillary vein cannulation as a safer alternative to landmark-guided subclavian access. Because the axillary vein lies entirely outside the thoracic cavity, ultrasound-guided puncture at this site preserves the benefits of subclavian catheterization while significantly reducing the risk of pneumothorax and hemothorax. Meta-analytic data indicate higher first-pass success rates and lower mechanical complication rates with ultrasound-guided axillary access compared to landmark subclavian techniques, reinforcing the value of ultrasound in redefining what is traditionally labeled as "subclavian" cannulation .

Despite these advances, widespread adoption of ultrasound-guided subclavian cannulation has been hindered by training gaps. As landmark techniques fell out of favor and subclavian access was deprioritized, procedural experience declined among clinicians and trainees. Ultrasound guidance alone does not eliminate the need for deliberate skill acquisition. High-fidelity simulation models and structured curricula have emerged as effective tools to restore competency, allowing practitioners to rehearse needle visualization, probe manipulation, and complication management in a controlled environment. Simulation-based education is particularly valuable for maintaining proficiency in high-risk, low-frequency procedures and has demonstrated strong face validity among experienced clinicians .

From an educational perspective, ultrasound-guided subclavian cannulation demands integration of cognitive anatomy, image interpretation, and psychomotor coordination. Successful performance requires understanding not only vascular anatomy, but also the dynamic relationship between probe orientation, needle angle, and ultrasound artifacts. Structured training programs that emphasize image acquisition, needle tracking, and error recognition are essential to translate theoretical safety benefits into real-world outcomes.

In clinical practice, ultrasound-guided subclavian cannulation should be viewed as a complementary skill rather than a competing alternative to internal jugular or femoral access. Patient-specific factors—including infection risk, duration of therapy, mobility needs, and existing vascular access—should guide site selection. Ultrasound expands the clinician's ability to tailor access strategies to individual patients, rather than defaulting to a single approach based on habit or perceived ease.

In conclusion, ultrasound-guided subclavian cannulation represents a mature, evidence-supported technique that reconciles the historical advantages of subclavian access with modern safety standards. By enabling real-time visualization, accommodating anatomic variability, and expanding access options across adult, pediatric, and neonatal populations, ultrasound has transformed subclavian cannulation from a high-risk procedure into a controlled, reproducible intervention. Continued emphasis on precise terminology, structured training, and simulation-based education will be essential to fully integrate this technique into routine clinical practice and to ensure that its benefits are consistently realized.

References:
1- Lausten-Thomsen U, Merchaoui Z, Dubois C, Eleni Dit Trolli S, Le Saché N, Mokhtari M, Tissières P: Ultrasound-Guided Subclavian Vein Cannulation in Low Birth Weight Neonates. Pediatric Critical Care Medicine. 18(2):172–175, 2017
2- Saugel B, Scheeren TWL, Teboul JL: Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Critical Care. 21(1):225, 2017
3- Yamamoto T, Arai Y, Schindler E: Real-time ultrasound-guided supraclavicular technique as a possible alternative approach for Hickman catheter implantation. Journal of Pediatric Surgery. 55(6):1157–1161, 2020
4- Davies TW, Montgomery H, Gilbert-Kawai E: Cannulation of the subclavian vein using real-time ultrasound guidance. Journal of the Intensive Care Society. 21(4):349–354, 2020
5- Zhou J, Wu L, Zhang C, Wang J, Liu Y, Ping L: Ultrasound guided axillary vein catheterization versus subclavian vein cannulation with landmark technique: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 101(43):e31509, 2022
6- Tanwani J, Nabecker S, Hiansen JQ, Mashari A, Siddiqui N, Arzola C, Goffi A, Peacock S: Use of a Novel Three-Dimensional Model to Teach Ultrasound-guided Subclavian Vein Cannulation. ATS Scholar. 4(3):344–353, 2023
7- Gawda R, Czarnik T: Ultrasound-guided infraclavicular cannulation of the subclavian vein – still an ongoing misconception. Journal of the Intensive Care Society. 24(3 Suppl):10, 2023