I’ve performed countless subclavian central line placements using anatomic landmarks; however, more recently, I’m preferentially utilizing ultrasound to cannula the vein from an infraclavicular approach.
Because of the proximity of the clavicle to the subclavian artery and vein, I start laterally to locate the axillary artery and vein short axis. Then, I rotate my linear ultrasound probe to a long-axis view of the vein identifying the pleura and pectoralis major muscle (PMM).
This is the one time I preferentially cannulate a vessel in the long axis, so I can keep my needle tip and shaft visualized at all times to avoid back-walling the vein into the pleura causing a pneumothorax.
