Brachiocephalic veins: An overlooked approach for central venous catheterization

Abstract

Central venous access is important in both assessment and treatment of the patient. In modern clinical practice, a percutaneous approach is preferred. The well-established subclavian and internal jugular vein catheterization techniques, however, still carry the risk of major acute complications. In this article we describe a trial study of a percutaneous brachiocephalic vein catheterization technique conducted on a total of 74 cadavers undergoing autopsy. Relying on constant and easily recognizable anatomical landmarks, we performed a total of 128 catheterizations of the right and left brachiocephalic veins. The success of catheterization was ascertained by regional dissection. Our results show very high reproducibility with a success rate of about 97% on the first attempt of catheterization on both right and left sides. Equally important, collateral injury of neighboring structures was consistently absent. We propose the introduction of this rather overlooked approach into clinical practice.

Ultrasound‐guided totally implantable venous access device through the right innominate vein in older patients is safe and reliable

“…INV cannulations might not have gained popularity because of early reports of pneumothorax in 1969 . Thus, some authors call the INV approach “an overlooked approach” or “the forgotten central line” . With the introduction of US into routine clinical practice, the INV approach has regained interest because of the superficial location of INV and lack of bone overlying the vein, thus making it possible to visualize the entire path of the needle during cannulation.…”

Multiple Variations of the Superficial Jugular Veins: Case Report and Clinical Relevance

“…Even simple anatomical variations may cause venous catheterization to be difficult or impossible (15). Anatomical landmarks that are vague or hard to recognize, anatomical variations and inexperience of the operator are among the factors causing complications (4). Apparently, the usage of ultrasound-guided catheterization provides great assistance in cases of superficial jugular veins' variations (13).…”

Use of a Lateral Infraclavicular Puncture to Obtain Proximal Venous Access with Occluded Subclavian/Axillary Venous Systems for Cardiac Rhythm Devices

“…The critical care and renal literature are replete with references for the direct use of the brachiocephalic vein for venous access, dialysis, and tunneled medication ports . Much of the preliminary information concerning brachiocephalic venous access comes from a cadaveric infraclavicular study by Badran et al evaluating the brachiocephalic approach for central venous catheterization.…”