ATLS(R)'s providor manual states its at the junction of medial and middle thirds of clavicle so does medscape.
http://emedicine.medscape.com/article/80336-overview#a7
whereas the just in time video for the same program states its the junction of lateral 1/3 and medial 2/3 of clavicle.
Does anyone knows any new guidelines ?
1 cm below the junction of lateral and medial 2/3 of the clavicle, directed towards the suprasternal notch
Skin puncture lateral 1/3& medial 2/3 of clavicle Where as actual puncture of vien will be at medial 1/3 & lateral 2/3rd of clavicle.
Some body mentioned supraclavicular approach for puncture of SCVein .I did not understand that If any body know?
Dear Ahmad Uzair Quraishi,
Though I prefer to insert CV line in the medial third of clavicle due to most rewarding aspiration of blood and correct cannulation,but I prefer to use internal jugular vein ,because the incidence of stenosis is remarkabe.This will bring a serious problem in chronic renal failure patients and venous hypertension and arm edema will ensue after making an arteriovenous fistula.
with best regards; Dr.khoshnevis Jalaluddin
no puncture without ultrasound, it is a fast and simply self-explanatory operation
- Dear Alfred Obermayer,
I use the ultrasound guide insertion only in the situation with I failed blind puncture
Dear Komet Thongkhao,
Please use ultrasound guide insertion from the outset for avoiding "failed blind puntures" ... it is easy to learn and handle
If you see an obstruction/obliteration (following former punctions , infection, thrombosis,..) of the subclavian vein ... you will smile - doing no "blind puncture" - and you will switch to ultrasound guide insertion of internal jugular vein or the opposite side.
We see and expect increasing difficulties because of chemotherapies, port catheter systems, i.e..
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