Trick of the Trade: Ultrasound-guided supraclavicular central line

Subclavian central lines are commonly touted as the central line site least prone to infection and thrombosis. The problem is that they are traditionally performed without ultrasound guidance. They are done blindly because of the transducer's difficulty in getting a good view with the clavicle in the way.

Trick of the Trade:
Ultrasound-guided supraclavicular approach to subclavian line

What are the surface anatomy landmarks for the supraclavicular line?

• Identify the border of the clavicle and lateral margin of the clavicular belly of the sternocleidomastoid muscle. 
• Insert the needle there and aim for the contralateral nipple, aiming anteriorly 10-20 degrees to avoid puncturing the subclavian artery and lung.
• You are trying to cannulate the near the juncture of the IJ and subclavian veins. 

If you just want to see the crux of the procedure, which uses the linear transducer to guide the long-axis needle insertion approach, start at 8:18.

Disclaimer: I do not have any commercial affiliations with Sonosite.

Reference
Patrick SP, Tijunelis MA, Johnson S, Herbert ME. Supraclavicular subclavian vein catheterization: the forgotten central line. West J Emerg Med. 2009 May;10(2):110-4. Free access to PDF