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The first rib as a fluoroscopic marker for subclavian vein access
P F Jaques1, W E Campbell, S Dumbleton
1Department of Radiology, School of Medicine, University of North Carolina, Chapel HIll 27599-7510, USA.
Summary
The first rib serves as a reliable fluoroscopic landmark for safe subclavian vein (SCV) puncture. This anatomical relationship allows for consistent SCV access without requiring ultrasound guidance.
Area of Science:
- Vascular anatomy
- Interventional radiology
Background:
- Subclavian vein (SCV) access is a common procedure in critical care.
- Accurate anatomical knowledge is crucial for safe SCV puncture.
Purpose of the Study:
- To assess the constancy of the anatomical relationship between the subclavian vein and the first rib.
- To determine if the first rib can be used as a reliable fluoroscopic marker for SCV access.
Main Methods:
- Subclavian venograms from 42 patients were analyzed to map the SCV's position relative to the first rib.
- SCV access procedures were performed using the first rib as a fluoroscopic landmark.
- Technical success, complications, and needle passes were recorded.
Main Results:
- The SCV's position relative to the first rib demonstrated a consistent anatomical relationship.
- 100% technical success rate was achieved in SCV access using the first rib as a marker.
- Minor complications occurred in two cases, with no lasting sequelae.
Conclusions:
- The first rib is a reliable and constant fluoroscopic landmark for safe subclavian vein access.
- Ultrasound guidance or contrast material is not necessary for SCV puncture when using the first rib marker.