Sonoanatomic examination of the subclavian vein in the supraclavicular region

INTRODUCTION AND AIM: Subclavian vein (SKV) catheterization can be performed in adult patients at the supraclavicular region under ultrasonography (USG) guidance. In our study, we aimed to examine the sonoanatomy of this region by ultrasound imaging of the SKV at the supraclavicular region in volunteers. MATERIALS AND METHODS: Twenty volunteers (10 male and 10 female) aged between 18 and 65 were included in our study. Demographic data were recorded and clavicle length of the volunteers were measured. The following data were obtained: SKV diameter, SKV-skin distance, SKV-sternocleidomastoid muscle (SKM) distance, SKV-pleura and SKV-clavicle distances were measured by USG. The distance between the SKV-skin and the SKV diameter were measured at the junction of the SKV-brachiocephalic vein (BSV), at medial 1/3 part of the clavicle and middle 1/3 part before and after the arm pulling maneuver. RESULTS: The mean distance between the SKV and the pleura was found to be 9.16 ± 1.26 mm at the medial 1/3 of the clavicle. The average SKV diameter was 9.47 ± 1.78 mm and the SKV-skin mean distance was measured as 10.55 ± 2.01 mm before arm pull,. The mean SKV diameter was measured as 9.87 ± 1.75 and the SKV-skin distance was 10.44 ± 2.67 after arm pulling. The ideal probe angle for SKV catheterization was found 12.75 ± 7.16 degrees relative to the coronal plane, and the ideal needle entry point was 4.53 ± 0.70 cm from the medial head of the clavicle. CONCLUSION: We performed measurements of the diameter of the SKV in the supraclavicular region, its distance to the skin, its distance to the pleura, its distance to the clavicle and the SKM. We concluded that the SKV diameter and SKV skin distance did not change significantly at the junction of SKV with BSV, at 1/3 medial and at 1/3 middle parts of the clavicle after the arm pulling maneuver. The SKV-pleural distance in the supraclavicular region was greater than the SKV-pleural distances measured in the infraclavicular region in the literature. We believe that knowing the ideal needle insertion location and the ideal probe angle for catheterization in the supraclavicular region will be a useful guide for physicians. Keywords: Pleura, central venous catheter, subclavian vein, supraclavicular, ultrasonography