Supraclavicular Subclavian Vein Catheterization: A Forgotten Central Line

Advantages of the supraclavicular approach over infraclavicular technique include:

• a well-defined insertion landmark (the clavisternomastoid angle);
• a shorter distance from skin to vein;
• a larger target area;
• a straight path to superior vena cava; less proximity to lung; and
• fewer complications of pleural or arterial puncture.
• The supraclavicular approach less often necessitates CPR or tube thoracostomy interruption than the infraclavicular approach.
• A finder or seeker needle (21G and 3.5 cm length) can be used to locate vessel, which minimizes the risk of complications. A finder needle is used mostly when ultrasound is not available during insertion of the internal jugular vein, but it may also help locate the subclavian vein via a supraclavicular approach. The needle should be inserted 1 cm posterior to the sternocleidomastoid and 1 cm cephalad to the clavicle.

 

References:

1. Patrick SP, Tijunelis MA, Johnson S, Herbert ME. Supraclavicular subclavian vein catheterization: the forgotten central line. West J Emerg Med. 2009 May;10(2):110-4. PMID: 19561831; PMCID: PMC2691520.

2. Borisov B, Iliev S. Supraclavicular Approach to the Subclavian Vein - One Well Forgotten Technique with Impressive Results. Pol Przegl Chir. 2019 Jun 6;91(4):19-23. doi: 10.5604/01.3001.0013.2281. PMID: 31481642.