Describe the anatomy relevant to central venous access (including
femoral, internal jugular, external jugular,subclavian and peripheralveins)
The subclavian vein:
- Is a continuation of the axillary vein as it crosses the upper surface of the first rib
- Travels posterior to the clavicle, separated from the subclavian artery by the anterior scalene
- Joins with the internal jugular vein to form the brachiocephalic vein
- Anteriorly by the clavicle, subclavius muscle, and pectoralis major
- Posteriorly by anterior scalene muscle and subclavian artery
- Inferiorly by first rib and lung apex
- Superiorly by skin, subcutaneous tissue, and platysma
- Medially by the brachiocephalic vein
- Laterally by the axillary vein
The needle is placed in the deltopectoral groove, inferior and lateral to the middle third of the clavicle. The needle is inserted at a shallow angle, passing under the middle third of the clavicle aiming at the sternal notch.
- McMinn, RMH. Last's Anatomy: Regional and Applied. 9th Ed. Elsevier. 2003.