Supraclavicular Right Subclavian Vein in Pediatrics

The supraclavicular access technique for the subclavian vein is performed using a long-axis (LAX) view. Notably, the right subclavian vein is shorter than the left. The dynamic needle tracking (DNT) technique is essential to avoid breaching the posterior wall of the subclavian vein, as the pleura is adjacent to this posterior wall. The needle’s trajectory in this method is from anterior to posterior, in contrast to the infraclavicular approach where the needle orientation is parallel to the pleura. Consequently, the smaller the patient, the smaller the diameter of the vein, making it easier to inadvertently puncture through the vein. In larger patients (typically those older than approximately 8 years), the vein’s diameter is larger, facilitating easier cannulation of the vessel without the risk of transversing it. Unlike other subclavian vein access routes (infraclavicular or extrathoracic), this method does not carry the risk of the guidewire deviating toward the ipsilateral jugular vein.