Placement of subclavian venous catheters
- Alan C Heffner, MD
Alan C Heffner, MD
- Director of Critical Care
- Director of ECMO Services
- Pulmonary and Critical Care Consultants
- Department of Internal Medicine
- Department of Emergency Medicine
- Carolinas Medical Center
- Associate Clinical Professor
- University of North Carolina School of Medicine
- Mark P Androes, MD
Mark P Androes, MD
- Assistant Professor of Surgery
- University of South Carolina School of Medicine
- Section Editors
- David L Cull, MD
David L Cull, MD
- Section Editor — Arterial and Venous Access
- Clinical Professor, Department of Surgery
- University of South Carolina School of Medicine
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
Central catheters provide dependable intravenous access and enable hemodynamic monitoring and blood sampling [1-3]. The subclavian veins are a common site for temporary central venous access, including tunneled catheters and subcutaneous ports for chemotherapy, prolonged antibiotic therapy, and parenteral nutrition.
Subclavian venous cannulation and catheter placement will be reviewed here. General considerations, complications of venous access, and issues related to other access sites are discussed elsewhere. (See "Overview of central venous access" and "Complications of central venous catheters and their prevention" and "Placement of jugular venous catheters" and "Placement of femoral venous catheters".)
The subclavian veins are reliable access points for temporary and permanent (eg, tunneled central catheters and subcutaneous ports) venous cannulation to support hemodynamic monitoring, fluid and medication administration, and parenteral nutrition (table 1). The left subclavian access is particularly well suited for cardiac access, including placement of pulmonary artery catheters, temporary transvenous pacer leads, and implantable pacers and defibrillators.
Subclavian venous access may be preferred for subcutaneous port placement due to the short distance between the subclavian vein and chest wall, making the catheter less prone to kinking.
Contraindications — Relative contraindications to subclavian venous catheterization include coagulopathy and altered local anatomy [4-8]. (See "Overview of central venous access", section on 'Contraindications'.)
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- SUBCLAVIAN VEIN ANATOMY
- SUBCLAVIAN SITE SELECTION
- GENERAL PREPARATION
- Skin preparation
- SUBCLAVIAN VEIN CANNULATION
- Needle access
- - General techniques
- Access with introducer needle
- Using a seeker needle
- Using an angiocatheter
- - Approaches to the subclavian vein
- Infraclavicular approach
- Supraclavicular approach
- Axillary approach
- Ultrasound guidance for subclavian access
- Venous confirmation
- CATHETER PLACEMENT
- Guidewire handling
- Tract dilation
- Positioning the catheter
- Catheter flushing and fixation
- CONFIRMATION OF SUBCLAVIAN CATHETER POSITION
- CATHETER MANAGEMENT
- SUMMARY AND RECOMMENDATIONS