Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter IX: Shock and Resuscitation

Infraclavicular Subclavian Catheterization

United States Department of Defense

Infraclavicular Subclavian Catheterization

1. Place the patient in a supine position, at least 15° head down to distend the neck veins and to prevent an air embolism. Turn the patient's head away from the venipuncture site.

2. Cleanse and prep the skin around the Venipuncture site and drape the area. Sterile gloves should be worn when performing this procedure.

3. Indroduce a large-caliber needle, attached to a 5 ml syringe, 1 cm inferior to the junction of the middle and medial thirds of the clavicle.

4. After the skin has been punctured, with the bevel of the needle upward, expel the skin plug that may occlude the needle.

5. Direct the needle medially, slightly cephalad, and posteriorly behind the clavicle towards the posterior, superior angle of the sternal end of the clavicle (toward a finger placed in the suprasternal notch).

6. Slowly advance the needle while gently withdrawing the plunger of the syringe.

7. When a free flow of blood appears in the syringe, remove the syringe and occlude the needle with a finger to prevent an air embolism.

8. Quickly insert the catheter to a predetermined depth such that the catheter does not rest within a cardiac chamber.

9. Remove the needle and connect the catheter to the IV tubing.

10. Suture the catheter in place, apply antibiotic ointment, dress the area, tape the tubing in place, and label the adhesive with the date of insertion.

11. Obtain a chest film to check the position of the IV line land to rule out pneumothorax

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Operational Medicine 2001

Health Care in Military Settings

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