Extrathoracic Left 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. Its proximity to the clavicle is associated with an increased diameter. Positioning a roll under the patient’s shoulders is not required for puncturing this vein. This chapter presents the long-axis (LAX) view puncture technique, utilizing dynamic needle tracking (DNT) for complete visualization of the introducer needle (in-plane technique). The most technically demanding aspect involves precise alignment of the introducer needle with the transducer’s insonation area, crucial for reducing inadvertent puncture of the posterior wall. It is advisable to confirm the guidewire location before proceeding with dilation, as there is a propensity for the guide to deviate toward the ipsilateral jugular vein; redirection toward the left brachiocephalic vein (LBCV) may be necessary.