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A subclavian line is a long, thin catheter used to directly administer fluids or medications into the subclavian vein. It is similar in function to traditional intravenous (IV) therapy, but it has several distinct advantages in patient care: Subclavian lines give direct access to the venous system; can be used to administer large amounts of medication, fluid, or nutritional supplements; allow physicians to monitor central venous pressure; and can stay in place for long periods of time. Another major advantage is that it allows for regular withdrawal of blood samples without disturbing the patient. The subclavian line is just one of several types of central venous lines that can be used.
It is common for the patient to receive either IV sedation or general anesthesia during the placement of a subclavian line. Local anesthetic is then used to numb the area, and a small incision is made. The physician inserts a thin catheter into the vein and threads it into a larger vein that carries blood directly in to the heart. It is common for the patient to feel some discomfort in the area for several days following the procedure, but most patients report the post-procedure discomfort to be minimal.
A tunneled catheter approach is often used when the subclavian line is expected to remain in place for extended periods of time. This method allows the catheter to "tunnel" under the skin and exit at a different location. This makes movement much easier for the patient and the access port less visible, as it would otherwise protrude directly from the neck. Tunneled catheters can also be used in central venous lines located in the groin or arm. These types of central lines are often used to administer chemotherapy to cancer patients or for regular blood transfusions in individuals with sickle cell anemia.
There are two subclavian veins, one on each side of the body. They are large veins with diameters similar to that of a pencil. Physicians often use the portion of the subclavian vein that runs directly behind the clavicle as the access point. Using larger veins, such as the subclavian, increases the likelihood of successfully inserting the catheter the first time because their location can be predicted more accurately than that of smaller veins, such as those in the arms or hands. This prevents the patient from having to endure multiple attempts to find a vein and reduces the risk of infection by limiting the number of breaks in the patient's skin.
Despite the many advantages of using subclavian lines there are several risks to consider as well. Up to 15% of individuals who undergo this procedure will experience some type of complication. Infection is possible any time there is a break in the skin and must be taken into consideration. Other complications include mechanical problems with the catheter or within the vein itself. The use of ultrasonography has greatly reduced the risks associated with improper placement of the catheter.