Procedure

Ultrasound-Guided Subclavian Vein Catheterization

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Ultrasound-Guided Subclavian Vein Catheterization, Subclavian Line, Subclavian Central Line, Subclavian Vein Catheterization, Catheterization of Subclavian Vein

  • See Also
  1. Central IV Access
  2. Intravenous Access
  3. Peripheral IV Access
  4. Intraosseous Access
  5. Subclavian Line
  • Indications
  1. See Central IV Access
  • Contraindications
  1. See Central IV Access
  • Adverse Effects
  1. See Central IV Access
  2. Precautions
    1. Subclavian Line malposition into the internal Jugular Vein (may advance to CNS)
    2. Subclavian vein is a noncompressible site (Hemorrhage risk)
  • Preparation
  1. Anatomy
    1. Subclavian vein runs in parallel and well anterior to the subclavian artery
    2. Subclavian Vein courses between the clavicle and anterior first rib (and anterior scalene Muscle)
    3. Subclavian artery, is in contrast, posterior to the first rib and scalene Muscle
    4. Pleural is posterior to subclavian artery (and first rib, anterior scalene Muscle)
  2. Patient positioning
    1. Patient supine and flat on the gurney
      1. If patient hunched forward, vertically oriented towel roll between Scapulae may be needed
      2. Avoid excessive retraction of Shoulders
    2. Trendelenburg position (10-15 degrees head down) to engorge subclavian vein
    3. Head in neutral position (without neck rotation)
      1. Slight neck rotation (15 degrees) toward needle entry side may prevent malposition into IJ vein
    4. Ipsilateral arm rests at patient's side
      1. Arm may be adjucted slightly in patients with large deltoid Muscles
  • Technique
  • Landmark-Based Entry
  1. External landmarks
    1. Sternal notch
    2. Medial curve of clavicle
      1. Junction of medial and middle third of clavicle
      2. Visible or palpable landmark in many patients (may be difficult in obese patients)
  2. Needle entry
    1. Enter 1 cm lateral and 1 cm inferior to medial curve of clavicle
      1. Do NOT enter skin too closely to the clavicle (needle will be unable to clear clavicle)
      2. Needle insertion too close to clavicle is among the most causes of Subclavian Line failure
    2. Direct needle to 1 finger breadth above the sternal notch
      1. Needle should course parallel to the floor
    3. Directed immediately beneath the clavicle
      1. May walk the needle beneath the clavicle (use Anesthetic)
    4. Subclavian vein should be within 5-6 cm of skin entry
      1. Use negative pressure on syringe while advancing needle
      2. Hub the needle first (advancing needle slowly) before redirecting
      3. Slightly advance the needle (3 mm) after seeing initial flash of blood
  3. Precautions (common causes of Subclavian Line failure)
    1. Insertion position incorrect (esp. entry too close to clavicle)
    2. Landmark indentification incorrect
    3. Needle insertion too shallow or into clavicle periosteum
    4. Needle directed too cephalad
  • Technique
  • Catheter Insertion and Securing Line
  1. Catheter insertion depth
    1. Right subclavian: Height (cm)/10 (or approximately 15 cm)
    2. Left subclavian: Height (cm)/10 + 4 cm (or approximately 17 cm)
  2. Line holders
    1. See Central Line
  • References
  1. Rutherford (2025) Anatomy of Central Venous Access, Hospital Procedures Course, attended 9/12/2025