[A safe method for infraclavicular puncture of the subclavian vein]

Investigations of 25 human cadavers, using various anatomical techniques, led to the development of a safe and simple method of subclavian venipuncture. This method was tested with special regard to possible complications. The authors describe the guidelines for the choice of the point where the skin has to be penetrated as well as of the point towards which the needle has to be directed. While the latter is situated a little beyond the spinous process of the seventh cervical vertebra, the other is determined as follows: the distance between the acromion and the sternoclavicular joint is divided into three parts, and the junction between the medial and central third of this distance is marked on the skin. Starting from this point a vertical is dropped towards the line between the acromion and the sternal angle. The point of intersection between this line and the vertical is where the cannula penetrates the skin. After a distance of between 2.5 and 4.5 cm the top of the needle reaches the subclavian vein. Even if the vessel is pierced through and through, no complication such as pneumothorax, laceration of arteries, lesions of the adjacent nerves, etc., can occur. Using this method the authors performed catheterization of the subclavian vein in 200 patients, and there were no complications at all.