Subclavian Venipuncture
(infraclavicular approach)

1. Pt supine.  15o head down to distend neck veins & prevent air embolism (watch c-spine - if excluded turn head away from site).
2. Cleanse, drapes, sterile gloves.
3. Local anaesthetic if awake.
4. Large caliber needle attached to a 10ml syringe with 1ml saline 1cm: insert 1cm below the junction of the middle and medial thirds of the clavicle.
5. After skin puncture, keep bevel upward, expel skin plug that may be occluding the needle.
6. Hold needle and syringe parallel to the frontal plane.  Direct medially, slightly cephalid and posteriorly behind the clavicle toward the posterior superior angle to the sternal end of the clavicle (toward a finger placed in the suprasternal notch).
7. Slowly advance while withdrawing the plunger of the syringe.
8. When free flow of blood occurs, rotate bevel of needle caudially, remove syringe and occlude with finger to prevent an air embolism.
9. Insert guidewire while monitoring the ECG.  Remove needle over guidewire.
10. Insert catheter over the guidewire to a predetermined depth (tip should be above right atrium for fluid administration).
11. Connect IV tubing and affix to skin with suture, taping tubing in place also.
12. Get a chest film.

Pneumo, haemo-thorax.
Venous thrombosis
Arterial / neurologic injury
Arteriovenous fistula
Air embolism