It is quite difficult to imagine modern intensive care without a cervical vein catheterization procedure. For the introduction of the catheter, the subclavian vein is most often used. This procedure can be performed both below and above the collarbone. The insertion site of the catheter is determined by a specialist.
This method of vein catheterization has a number of advantages: the introduction of the catheter is quite simple and comfortable for the patient. This procedure uses a central venous catheter, which is a long, flexible tube.
Clinical Anatomy
The subclavian vein collects blood from the upper limb. At the level of the lower edge of the first rib, it continues with the axillary vein. In this place, it goes around the first rib from above, and then runs along the anterior edge of the scalene muscle behind the clavicle. It is located in the preglacial space. This space is a frontal triangular gap, which is formed by the groove of the vein. It is surrounded by the scalene muscle, sternothyroid, sternohyoid muscle and clavicular-mastoid muscle tissue. subclavian veinlocated at the very bottom of this gap.
Passes through two points, while the lower one is located at a distance of 2.5 centimeters inward from the coracoid process of the scapula, and the upper one goes three centimeters below the sternal edge of the end of the clavicle. In children under five years of age and newborns, it passes in the middle of the clavicle. The projection shifts to the middle third of the clavicle with age.
The vein is located slightly obliquely relative to the center line of the body. When moving the arms or neck, the topography of the subclavian vein does not change. This is due to the fact that its walls are very closely connected with the first rib, subclavian muscles, clavicular-thoracic fascia and clavicular periosteum.
Indications for CPV
The subclavian vein (pictured below) has a fairly large diameter, making it the most comfortable catheterization.
The procedure for catheterization of this vein is indicated in the case of:
- Upcoming complex surgery with possible blood loss.
- Intensive Care Needs.
- Pacemaker insertion.
- Need to measure central venous pressure.
- Parenteral nutrition.
- The need for probing the cardiac cavities.
- Open heart surgery.
- The need for X-ray contrast studies.
Catheterization technique
EAP should be heldexclusively by a specialist and only in a room specially equipped for such a procedure. The room must be sterile. For the procedure, an intensive care unit, an operating room or a conventional dressing room is suitable. In the process of preparing the patient for CPV, it must be laid on the operating table, while the head end of the table should be lowered by 15 degrees. This should be done in order to exclude the development of an air embolism.
Methods of puncture
Puncture of the subclavian vein can be performed in two ways: supraclavicular access and subclavian. In this case, the puncture can be done from any side. This vein is characterized by good blood flow, which, in turn, reduces the risk of thrombosis. There is more than one access point during catheterization. Experts give the greatest preference to the so-called Abaniac point. It is located on the border of the inner and middle thirds of the clavicle. The success rate of catheterization at this point reaches 99%.
Contraindications for CPV
CPV, like any other medical procedure, has several contraindications. If the procedure fails or is not possible for any reason, then the jugular or internal and external femoral veins are used for catheterization.
Puncture of the subclavian vein is contraindicated in the presence of:
- Disorders of blood coagulation and hypocoagulation.
- Superior vena cava syndrome.
- Paget-Schroeter syndrome.
- Local inflammatory process at the intended site of catheterization.
- Bilateral pneumothorax.
- Emphysema or severe respiratory failure.
- Clavicle injury.
It should be understood that all the contraindications listed above are rather relative. In case of a vital need for CPV, urgent access to the veins, the procedure can be performed without taking into account contraindications.
Possible complications after the procedure
Most often, catheterization of the subclavian vein does not entail serious complications. Any change in the catheterization process can be identified by bright red pulsating blood. Experts believe that the main reason why complications occur is that the catheter or guidewire was incorrectly placed in the vein.
Such an error can provoke the development of such unpleasant consequences as:
- Hydrothorax and fiber infusion.
- Venous wall perforation.
- Subclavian vein thrombosis.
- Knotting and twisting of the catheter.
- Migration of the catheter through the veins.
- Irregular heart rhythm.
In this case, adjustment of the catheter position is required. After the port is amended, it is required to contact consultants who have extensive experience. If necessary, the catheter is removed completely. In order to avoid deterioration of the patient's condition, it is necessary to immediately respond to manifestations of symptoms of complications, especiallythrombosis.
Prevention of complications
In order to prevent the development of an air embolism, strict adherence to the tightness of the system is required. After the procedure is completed, all patients who have undergone it are prescribed x-rays. It prevents the formation of pneumothorax. Such a complication is not excluded if the catheter was in the neck for a long time. In addition, vein thrombosis, the development of air embolism, multiple infectious complications, such as sepsis and suppuration, catheter thrombosis may occur.
To prevent this from happening, all manipulations should be carried out only by a highly qualified specialist.
We examined the anatomy of the subclavian vein, as well as the procedure for its puncture.
