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Question No. 2
Q: What is the course of the subclavian vein? (2 marks)
Answer No. 2
- The continuation of the axillary vein (1)beginning at the lower border of the 1st rib 1
- Initially arches upwards across the rib
- Once over the rib angles medially and downwards to join with the internal jugular vein behind the sternoclavicular joint (1)
- Lies beneath the clavicle for most of its course (1)
- Following the merger with the internal jugular vein continues as the brachiocephalic (innominate) vein (1) continuing towards the mediastinum:
- Not symmetrical bilaterally
- Left side arcs gently through the innominate vein to the superior vena cava whilst the right side angles sharply
- Can cause difficulty inserting right sided catheters leading to kinking or passing into the left subclavian vein
2
Question No. 4
Q: What are the landmarks for subclavian vein central venous catheter insertion? (4 marks)
Answer No. 4
Technique
Infraclavicular (Classical)
- Insertion point is 1-2cm inferior 1to the point of the middle and lateral thirds of the clavicle 1
- Needle passed under the clavicle 1 aiming toward the junction of the middle and medial thirds1
- Needle should be kept flat using finger and never angled posteriorly to avoid arterial or pleural puncture
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