Anatomical bases for a safe method of subclavian venipuncture

Abstract

Based on fundamental anatomical considerations which are explained in detail we developed a safe technique for the catheterization of the subclavian v.: the point of puncture, which is situated about 25 mm below the junction between the medial and the middle thirds of the clavicle, is accurately determined with the help of a pattern described in the paper. The needle is directed towards the palpable dimple between the spinous processes of the 6th and the 7th cervical vertebrae. The only structure the cannula can reach is the medial portion of the subclavian v. into which the catheter is inserted. Therefore pneumothorax, haemothorax or other incidents do not occur. The method was tested in 350 cases and proved to be absolutely free of complications.

Is Ultrasound-guided Central Venous Port Placement Effective to Avoid Pinch-off Syndrome?

“…A few years later, some reported that POS was not only caused by compression between the clavicle and the first rib but by entrapment in the subclavius muscle-costocoracoid ligament complex which compressed the catheter during shoulder motion (21, 22). Standard landmark guidance venipuncture is started for insertion at the medial or middle third of the clavicle, and the needle is lowered to run parallel to but beneath (sliding the needle down) the clavicle (23–25). This technique is prone to a more medial approach and has a risk of traversing the subclavius muscle or costocoracoid ligament.…”

A modified dissection method to preserve neck structures

“…The anatomical relationships between the first rib and clavicle are key to the successful placement of central venous catheters as well as pacemaker and defibrillator leads (Magney et al, 1993). Common complications of this procedure include pneumothorax or hemothorax, venous thrombosis and puncture of the subclavian artery, injury to the brachial plexus, phrenic or vagus nerves, and Horner's syndrome (Lechner et al, 1989;Boon et al, 2007). Appreciation of the role of the soft tissue inferior to the medial end of the clavicle (e.g., the subclavius muscle and costoclavicular ligaments) in the entrapment of the catheter or lead is also necessary for understanding the proper placement of these devices as well as their possible dysfunction (Magney et al, 1993;Krutchen et al, 1996;Jensen, 2008).…”

Anatomic considerations in placement of central venous catheters

“…Most authors recommend an infra-clavicular percutaneous approach to SV cannulation (Land, 1972;Linos et al, 1980;Untracht, 1988;Lechner et al, 1989), though others advocate a supra-clavicular approach, on the grounds of lower risk for complications (Parsa and Tabora, 1986). Attempts at percutaneous cannulation should be carried out with the patient in the supine position.…”