1.
Identify points St (sternal angle) and Cp (coracoid process) (Figure 7
on page 18).
[1] Subclavius muscle [2] Costocoracoid ligament [3] Costoclavicular ligament
Figure 7. Entry point for percutaneous subclavian venipuncture
2.
Visually draw a line between St and Cp, and divide the segment into
thirds. The needle should pierce the skin at the junction of the middle
and lateral thirds, directly above the axillary vein (point Ax).
3.
Place an index
fi
nger on the clavicle at the junction of the medial
and middle thirds (point V), beneath which point the subclavian vein
should be located.
4.
Press a thumb against the index
fi
nger and project 1–2 centimeters
below the clavicle to shield the subclavius muscle from the needle
(when hypertrophy of the pectoralis muscle is apparent, the thumb
should project about 2 centimeters below the clavicle because the
subclavius muscle should be hypertrophied as well) (Figure 8 on page
19).
18
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