The Supraclavicular Subclavian Central Venous Cathetherization
Central venous catheters (CVCs) are routinely placed in critically ill ED patients.
The literature has clearly demonstrated that CVCs placed in the subclavian vein have lower risks of infection and thrombosis when compared to the femoral and internal jugular vein routes.
Although we routinely teach the infraclavicular approach, don't forget the subclavian vein can also be cannulated via the supraclavicular approach.
Some pearls on the supraclavicular approach:
Identify the clavisternomastoid angle: formed by the lateral head of the sternocleidomastoid muscle (SCM) and the clavicle
Insert the needle 1 cm lateral to the lateral head of the SCM and 1 cm posterior to the clavicle
Direct the needle at a 45-degree angle aimed at the contralateral nipple
The right side is preferred due to a more direct route to the SVC and a lower pleural dome (decreasing the incidence of pneumothorax)
Place the patient in Trendelenburg position and aim the bevel of the needle downward
References
Patrick SP, Tijunelis MA, Johnson S, Herbert ME. Supraclavicular subclavian vein catheterization: The forgotten central line. West J Emerg Med 2009;10(2):110-4.
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