From the Guidelines
The subclavian vein is a large paired blood vessel located beneath the clavicle (collarbone) that forms part of the central venous system, and its location and clinical significance are crucial for central venous catheter placement and other medical procedures. The subclavian vein begins at the outer border of the first rib as a continuation of the axillary vein and joins with the internal jugular vein to form the brachiocephalic vein 1.
Clinical Significance
The subclavian vein is clinically significant as a common site for central venous catheter placement, particularly for central line access in emergency situations, long-term intravenous therapy, hemodialysis, and parenteral nutrition 1. Its large diameter and consistent anatomical position make it suitable for these procedures. However, catheterization carries risks including pneumothorax, arterial puncture, infection, and thrombosis 1.
Anatomical Considerations
Anatomically, the subclavian vein passes anterior to the scalenus anterior muscle and posterior to the clavicle, making it vulnerable during clavicular fractures 1. It also serves as an important collateral pathway for venous return when the superior vena cava is obstructed, highlighting its role in maintaining circulatory homeostasis 1.
Recommendations for Catheter Placement
The left subclavian vein is often preferred for catheterization as it provides a straighter path to the superior vena cava. Ultrasound-guided central venous catheter placement is recommended to reduce the risk of complications, including pneumothorax and arterial puncture 1. The use of real-time ultrasound guidance can help to visualize the anatomy and patency of the target vein, reducing the risk of complications and improving the success rate of catheter placement 1.
Risks and Complications
The risks and complications associated with subclavian vein catheterization include pneumothorax, arterial puncture, infection, and thrombosis 1. The use of ultrasound guidance and maximal barrier precautions can help to reduce the risk of these complications.
In summary, the subclavian vein is a critical blood vessel that plays a significant role in central venous catheter placement and other medical procedures. Its location and clinical significance must be carefully considered to minimize the risk of complications and ensure optimal patient outcomes.
From the Research
Location of the Subclavian Vein
- The subclavian vein is located under the clavicle and is part of the venous system that returns deoxygenated blood from the upper limb to the heart.
- It is connected to the axillary vein and the internal jugular vein via the brachiocephalic vein 2, 3.
Clinical Significance of the Subclavian Vein
- The subclavian vein can be affected by thrombosis, which can cause symptoms such as pain and edema in the upper limb 2, 3.
- Subclavian vein thrombosis can be caused by compression of the vein due to the presence of a thoraco-brachial outlet syndrome or by the placement of central venous catheters 2, 3.
- Treatment options for subclavian vein thrombosis include anticoagulation, thrombolysis, and surgical procedures such as decompression of the thoracic outlet and venous bypass 2, 3, 4.
- Surgical approaches to the subclavian vein include a subclavicular approach with removal of the first rib and scalenotomy, which can provide easy access to the innominate-subclavian-axillary vein segment 5.