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August 1967

The Infraclavicular VenipunctureValue in Various Clinical Situations Including Central Venous Pressure Monitoring

Author Affiliations

From the Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia. Dr. Mogil is currently a resident in Urology at the Hospital of the University of Pennsylvania. Dr. DeLaurentis is currently at Springfield (Mass) Hospital.

Arch Surg. 1967;95(2):320-324. doi:10.1001/archsurg.1967.01330140158036

MANY reports concerning the history and physiology of central venous pressure (CVP) monitoring have appeared.1-3 Its clinical value has been demonstrated. Our remarks will be confined to a description of over 200 percutaneous infraclavicular venipunctures.

Five closed-chest techniques have been used to monitor CVP. They are the femoral vein approach, the external jugular venipuncture, the supraclavicular subclavian venipuncture, the antecubital cutdown, and the infraclavicular venipuncture. We have used all five techniques and maintain that the procedure of choice is the percutaneous infraclavicular approach. Modifying Wilson's technique,1 one of us (R.A.M.) has done more than 200 subclavian catheterizations over a 1½-year period.

Technique  Before attempting this procedure, one must have thorough knowledge of the anatomy involved.4 The axillary vein becomes the subclavian as it crosses over the first rib. Just medial to this point, the vein lies immediately posterior to the medial third of the clavicle and is

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