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