SUBCLAVIAN VEIN



The subclavian vein, as its name suggests, lies below the clavicle, which is directly above the first rib. An extension of the large axillary vein, it begins at the outer border of the first rib, passes over the rib and extends to the inner end of the clavicle. There, it unites with the internal jugular vein forming the innominate (or brachiocephalic) vein. It is a large vessel with a high flow rate of 800-1200 cc blood flow per minute (11,12,16,17)

While the subclavian approach provides consistent landmarks and has the lowest associated risk of infection for chest access, the subclavian approach should be avoided in patients with coagulation disorders due to the inability to compress the subclavian site effectively. This site is associated with the highest risk for pneumothorax, a risk that should be considered prior to insertion. Rarely, patients can also experience "pinch-off syndrome," in which devices in the subclavian vein become compressed between the clavicle and first rib (18).