Describe and / or illustrate the anatomy relevant for the insertion of a central line into the left subclavian vein using any of the available techniques.
There are a few areas of anatomy that are essential for Intensivist to have a high level of
knowledge of. The subclavian vein is one of them. Unfortunately the extent of knowledge
displayed by the candidates was very shallow. A good answer required as a minimum, a clear
description of the course of the vein. This included the following facts – it is a continuation of
the axillary vein, it’s relationship to the first rib, to the medial border of the scalenus anterior,
the fact that it arches up, medial, then down and that it joins the internal jugular vein (behind
the subclavian joint, anatomical relationships (eg Anterior – clavicle, subclavius muscle,
Posterior – first rib, apex lung superiorly, first intercostal space inferiorly, Superior –
subclavian artery, thoracic duct medially, phrenic nerve, lower trunk brachial plexus laterally
and Medial – brachiocephalic artery, trachea, vagal trunk, thoracic duct and oesophagus
posteriorly) and surface anatomy (related to the various available techniques (eg the
infraclavicular and supraclavicular approach)
Syllabus – C1d, 2g
Reference: Anatomy for Anaesthetists, Ellis and Feldman