|
|
A D V E R T I S E M E N T
A D V E R T I S E M E N T
Bony landmarks help one visualize the position of the axillary and subclavian portions of the vein in the AP view. Halsted's ligament at the costoclavicular junction marks the transition of axillary to subclavian vein at the lateral border of the first rib. The start of the axillary vein is beneath the skin of the medial surface of the brachium. Between these two points, the vein follows a gentle arch along the tapering cone of the upper ribs and its mid-point lies beneath the tip of the coracoid process of the scapula and the attached pectoralis minor muscle. The coracoid is easily located as the medial most bulge of the shoulder. Most students when asked to locate this landmark mistakenly palpate in the depression between coracoid and clavicle thinking it is more posterior than it actually is.
A D V E R T I S E M E N T
Knowing the approximate course of the vein, one can plan a logical puncture site to maximize chances for entering the vein on the first try. Each false pass increases the chance of complications and results in extravasation and hematoma which make identification of the moment of puncture more difficult and compress the vein making a smaller target. The first try is the best chance for success. By puncturing skin along the imagined course of the vein at the junction of medial and lateral thirds of the clavicle one increases the probability of hitting the vein. The target point is ideally the terminal axillary vein lateral to Halsted's ligament. More central entry into the subclavian vein proper subjects the catheter to stress between the clavicle and rib with the danger of material fatigue causing the catheter to break off and embolize centrally. The point of skin puncture should take into account the length of the needle and depth of the vein at the intended puncture site to ensure adequate length.
Notes:
Link to this frame from your Personal Thumbnails page?
A D V E R T I S E M E N T
The angle of the needle in the frontal plane along the course of the vein is one of two critical angles necessary for proper three dimensional orientation. The second is the angle of the needle in cross-section. To accept the logic of this angle, one must understand the location of the subclavian vein in relation to the skin surface. The vein is posterior to the medial third of the clavicle, at least two centimeters deep to the skin surface in a thin individual. It lies on the anterior end of the first rib which diverges posteriorly from the clavicle and is thus behind the clavicle where it crosses the rib. It does not lie between the rib and clavicle. Only Halsted's ligament and subclavius tendon occupy that space.
Notes:
Link to this frame from your Personal Thumbnails page?
Click the "Update" button to save your Notes and Personal Thumbnails.
This page was last modified on 3/1/1999.
Clinical Folios:
Abdomen,
Biliary/Pancreatic,
Breast,
Cardiothoracic,
Colorectal,
Embryology,
Genitourinary,
Gynecology,
Head and Neck,
Hernia,
Musculoskeletal,
Neurosurgery,
Ophthalmology,
Pediatric Surgery,
Plastic Surgery,
Radiology,
Soft Tissue/Sarcoma,
Surgical Anatomy,
Technique,
Trauma,
Vascular | |
Discussions,
SCALpels
Personal Pages:
Thumbnails,
Presentations,
Quizzes
Home,
Image Archive,
About Vesalius,
Keyword Search,
Glossary
Logout