Morning Report: 7/10/2012

Today’s Morning Report is courtesy of Dr. Aherne:

Supraclavicular Subclavian Central Venous Access

Offers several advantages over infraclavicular approach:

• At the insertion site, the subclavian vein is closer to the skin
• Right sided approach provides a straighter path into the subclavian vein
• More accessible during CPR
• Less anatomical distortion in obese patients
• First rib protects against lung injury

Contraindications:

• Localized trauma to ipselateral side
• Coagulopathy

Insertion site:

• One cm lateral to lateral boarder of the of the clavicular head of the sternocleidomastoid muscle
• Needle approach should bisect the angle of the muscle boarder and the clavicle

Orient the bevel of the introducer needle caudally so as to facilitate downward progression

• The needle should be approximately parallel to the chest wall

Thanks Dr. Aherne!

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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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