While the supraclavicular approach to the subclavian vein has been described since 1965, it is generally employed much less often than the “traditional” infraclavicular approach. Although randomized trials are lacking, the best evidence suggests that the supraclavicular approach has a number of important advantages to the infraclavicular approach. The landmarks and relative merits of the procedure are described in this paper.

Most clinical studies on the supraclavicular approach are in the form of prospective case series. Only a few well designed, randomized prospective trials comparing the infraclavicular and supraclavicular methods have been described in the literature.

The literature clearly demonstrates the effectiveness of the supraclavicular approach using Yoffa’s original technique as well as modifications to landmarks, angles, and patient position (see Table).

No central venous access is without potential complications and no one technique is ideal for every patient. In conclusion, a thorough knowledge of anatomy and familiarity with multiple approaches is the route to successful central venous catheterization.

Read More