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Subclavian CVC

Reasons for insertion

  • IJ not accessible
  • Want a longer line with less infection risk

Insertion Technique (Landmark)

  • Place a bag of fluids wrapped in a towel between shoulder blades, high, to help retract shoulders a bit
  • Clean and drape everything
  • Window should be at clavicle, more lateral than medial
  • Set up as for a normal CVC (use a ~12cm line)
  • With non needle hand:
    • Feel sternal notch
    • Feel clavicle
    • Go to the point where the lateral third meets the middle third
  • Needle is going in at this point (well, about a cm lateral to this)
    • Start off pointing up towards head (also do this with anaesthetic needle to start with)
    • With shallow angle,
    • Bouncing way off clavicle on way in
    • Once under clavicle, point towards the sternal notch (so syringe is swinging out the way)
    • It's keeping a v shallow angle, but under clavicle,
    • Advance gently until withdrawing blood
    • Then insert like normal CVC

Sources