Subclavian vein cannulation: an approach with definite landmarks.

An interesting observation, ie, the coracoclavicular line (from the lower border of the coracoid process to the upper border of the medial head of the clavicle) was parallel to the subclavian vein catheter in bedside chest roentgenograms (anteroposterior view), prompted us to use this subclavian approach. After supine positioning of the patient with the arm alongside the body and the left shoulder elevated 10 to 15 degrees, the puncture point was selected 1.5 cm away from the point where the coracoclavicular line crossed inferior border of the clavicle on the skin. The needle was moved horizontally in the direction of the aforesaid line. In 205 attempts in adult patients, 95.6% patients had successful cannulation in first attempt without significant complication. This technique appears to be promising as it is based on observation and is guided by constant landmarks and precise direction.