Extrathoracic Right Subclavian Vein in Pediatrics

The extrathoracic subclavian vein is a short segment between the confluence of the cephalic and axillary veins and the lower margin of the clavicle, located in the deltopectoral groove. The vein is located medial to the artery. The vein’s proximity to the clavicle correlates with an increase in its diameter. This chapter describes the puncture technique using short-axis (SAX) visualization. To perform this technique and avoid complications associated with out-of-plane puncture, the dynamic needle tip positioning (DNTP) technique is used. DNTP helps prevent unintended punctures of surrounding structures. It is advisable to verify the guidewire location before proceeding with dilation, as it tends to deviate toward the ipsilateral jugular vein; redirection of the guidewire toward the inferior vena cava may be necessary.