> Procedural Ultrasound: Subclavian Access & Confirmation
Procedural Ultrasound

Subclavian Access & Confirmation

Subclavian Access


  • Can be approached from below (infraclavicular) or above (supraclavicular)
  • Becomes axillary vein after crossing first rib
  • Clavicle is barrier to ultrasound use for true subclavian but does visualize axillary, pleural line
sensor position

Narration

So subclavian central venous access is often performed blindly and it can be challenging to visualize the subclavian vein beneath the bony clavicle, but it can be approached either from below infraclavicular or above supraclavicular and ultrasound can be helpful for both of these approaches. Keep in mind that the subclavian vein becomes the axillary vein after it crosses the first rib and sometimes this is what you are visualizing and accessing. In this clip we can actually see that vein in long axis and we're also seeing the pleura which is pretty close, about a centimeter away, and that's an element you should be aware of as you are putting a needle in this area.


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