Question 18

Describe the anatomy of the left subclavian vein.

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College Answer

An ideal answer includes origin of subclavian vein, its tributaries, course in relation to mediastinal structures and surface anatomy for central line insertion. Vague comments like: “it follows the subclavian artery”, or “it passes between 1st rib and clavicle”, attract minimal marks. Similarly, no marks were awarded for describing technique of central line insertion and complications of procedure. Answers scored poorly due to a combination of the following, a lack of depth to their answers or inaccurate facts and limited structure/approach to an anatomical SAQ. Good answers described the course of the subclavian vein from its origin at the lateral border of the first rib, along the subclavian groove on the upper surface of the first rib, medially to its termination posterior to the sternoclavicular joint at the medial border of the scalenus anterior, where it joined the IJV to form the bracheoceaphalic vein. In addition, high scoring candidates described tributaries (e.g., the thoracic duct, external jugular) where they joined and went on to describe relations in reasonable detail, specifying whether patient is supine or erect.