Subclavian Deep Dive

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Harman Gill
Harman Gill
I am a proud Indian by ethnicity and Sikh by religion who lives in the lovely upper valley here in New Hampshire. I love to host, cook and engage in health conversations and loud debates where decibels can be raised but respect is never lost! Talk to you soon!
Matt Tyler
Matt Tyler

The Pre-brief

In this post, we will discuss the fundamental differences between the traditional landmark-based subclavian central line placement technique versus ultrasound-guided subclavian/axillary central line placement.

The Debrief

Basics of conventional/landmark-based subclavian central lines:

  • Anatomy: Placed at the junction of the medial and middle third of the clavicle 
  • Indications: Central venous access, infusion of vasoactive/caustic infusions, hemodynamic monitoring (namely CVP)
  • Risks: Bleeding, pneumothorax, and infection (although subclavian lines are considered to be least infection-prone) 
  • Procedure: Watch the video!

Basics of ultrasound guided subclavian/axillary central line:

  • Anatomy: Placed anywhere the axillary/subclavian vein is visualized with ultrasound
  • Indications: Same as above 
  • Risks: Same as above but less likely to cause pneumothorax as pleural line is under constant and direct visualization 
  • Procedure specifics: Watch the video! 
  • Literature supports the merits of this version of subclavian central line placement over the traditional, landmark based approach 
  • Can be technically challenging
  • Need to have strict control and visualization of the needle tip at all times 
  • Tips for troubleshooting…coming up next time!

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