Today’s Morning Report is courtesy of Dr. Aherne:
Supraclavicular Subclavian Central Venous Access
Offers several advantages over infraclavicular approach:
- At the insertion site, the subclavian vein is closer to the skin
- Right sided approach provides a straighter path into the subclavian vein
- More accessible during CPR
- Less anatomical distortion in obese patients
- First rib protects against lung injury
Contraindications:
- Localized trauma to ipselateral side
- Coagulopathy
Insertion site:
- One cm lateral to lateral boarder of the of the clavicular head of the sternocleidomastoid muscle
- Needle approach should bisect the angle of the muscle boarder and the clavicle
Orient the bevel of the introducer needle caudally so as to facilitate downward progression
- The needle should be approximately parallel to the chest wall
Thanks Dr. Aherne!
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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