Supraclavicular approach to subclavian vein

A series of subclavian vein catheterisations is described in patients using the supraclavicular approach, with a high success rate and few complications. 290 of the 370 patients were mechanically ventilated at the time of the procedure
How they did it:

  • The point of needle insertion was identified 1 cm cephalad and 1 cm lateral to the junction of the lateral margin of the clavicular head of the sternocleidomastoid muscle with the superior margin of the clavicle (claviculosternocleidomastoid angle)
  • The direction of the needle was indicated by the line that bisects the claviculosternocleidomastoid angle with elevation 5–15 degrees above the coronal plane.
  • The needle was advanced slowly with a constant negative pressure in the syringe.
  • The vein was usually punctured between the clavicle and the attachment of the anterior scalene muscle to the first rib.
  • The subclavian artery is situated posterior and slightly superior to the vein; if palpable, the pulse of the artery could be the important landmark
  • The depth of catheter insertion was 14 cm for right side and 18 cm for left side catheterization.

Supraclavicular approach is an easy and safe method of subclavian vein catheterization even in mechanically ventilated patients: analysis of 370 attempts
Anesthesiology. 2009 Aug;111(2):334-9
EMRAP.TV has a video on supraclavicular central line insertion here