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Invited Critique
September 01, 2003

Effect of Patient Position on Size and Location of the Subclavian Vein for Percutaneous Puncture—Invited Critique

Arch Surg. 2003;138(9):1001. doi:10.1001/archsurg.138.9.1001

The infraclavicular approach to the subclavian vein for central venous access is a common procedure performed for hemodynamic monitoring, for the administration of total parenteral nutrition, or for vascular access in patients where peripheral access is unavailable. Important considerations of central venous access in all patients, but critically ill patients in particular, include the success of catheterization and the morbidity of the procedure. The initial choice of venous access for resuscitation of injured patients differs from that needed in critically ill patients requiring hemodynamic monitoring or intravenous infusions. During trauma resuscitation, establishing rapid, safe venous access is imperative and is determined by the stability of the patient's condition and the types of injuries present. Furthermore, in the emergency care setting, where numerous tasks are often performed simultaneously, subclavian venous access may be challenging. For these reasons the subclavian vein is frequently not the initial choice of venous access during trauma resuscitation, especially when central venous monitoring is not an immediate concern.

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