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Subclavian Vein Approach

- See: subclavian artery and internal jugular approach

- Anatomy:
    - subclavian vein, which in the adult is approximately  3-4 cm long and 1-2 cm in diameter, begins as a continuation of the 
          axillary vein at the lateral border of the first rib, crosses over the first rib, and passes in front of the anterior scalene muscle;
    - anterior scalene muscle is approximately 10-15 mm thick & separates subclavian vein from the subclavian artery which runs 
          behind the anterior scalene muscle.
          - vein continues behind medial third of clavicle where it is immobilized by small attachments to the rib and clavicle;
    - at medial border of the anterior scalene muscle and behind sSC joint, the subclavian unites with the IJ to form the innominate,  or 
             brachiocephalic vein;
    - large thoracic duct on the left and smaller lymphatic duct on right enter superior margin  of subclavian vein near IJ junction; 

- Canulation Technique: 
    - pt to be well hydrated and sedated -
    - shoulder blades are thrown back on a towel roll placed beneath spinal column, thereby throwing clavicles backward;
    - pts head is neutral and T berg position of 15 deg;
    - local infiltration w/ No. 22 needle w/ lidocaine, especially into the periosteum of the clavicle;
    - local the left subclavian vein w/ a No. 22 gauge needle;
            - have introducer needle present inorder to retrace path;
    - ensure that the needle is kept no more than 10 to 15 deg from horizontal;
    - subclavian artery, lung, and brachial plexus are all posterior to subclavian vein; if the vein is not cannulated, at least the other structures will not be hit

The deltopectoral triangle as a landmark for percutaneous infraclavicular cannulation of the subclavian vein.

Avoiding complications and decreasing costs of central venous catheter placement utilizing electrocardiographic guidance.

Prevention of Intravascular Catheter–Related Infections. 

Central Venous Catheterization

Implement the Central Line Bundle

Central Venous Catheterization — Subclavian Vein

Effect of Patient Position on Size and Location of the Subclavian Vein for Percutaneous Puncture 

Intraosseous Catheter Placement in Children