lets get shruggy

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me: what’d the subclavian line say to the face? 

You: IDK man, its late **shrug**

me: GREAT BECAUSE THATS EXACTLY WHAT WE’RE GONNA TALK ABOUT!

THE. 

SHRUG.

TECH.

NIQUE. 

(for subclavian lines) 

First question:  why oh why choose a subclavian 

  1. Easier to keep clean and dry than a neck or groin (obvi)

  2. Lower risk of catheter associated  DVT 

  3. Avoids trach ties/collars - super useful now that those are all the rage

  4. Does impede venous drainage from the brain in Neuro patients

Second question: yeah you’re right and I get to get a chest tube from that pneumo I’m gonna cause!

WRONGITO!

Guys its 2020, I saw a robot type machine doodad named Marty roam a grocery store the other day. Times. Have. Changed. 

Lets talk ultrasound 

So here’s some technique, but don’t you worry your pretty little heart, I’ll include some videos at the end.  

So for this I’m going to describe short axis, but you can also do this long axis. 

You start lateral looking for that axillary vein 

Trace that bad boy medially and you’ll see it join up to a larger vessel. *spoiler alert -thats the subclavian* BOOM!

Here’s a view you might get 

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Note: long axis can be done but there have been studies shown that short axis actually has a higher success rate, go figs. But here’s a long axis ultrasound measure for good measure

2.png

Additional note: Ribs run between the subclavian and the pleura  and can be used strategical to prevent pneumothorax.

You: This is all great stuff, but its back day and you sold me this email on the shrugs. I’ve been real concerned about my traps so. 

Me: Shut it. Heres your shrugs.

So one thing is the subclavian tends to dive below that pesky clavicle, but you know what? 

You tell those patients to shrug or maybe you do a little creative arts and crafts, suddenly that clavicle  jumps up and that subclavian view comes right back. 

3.jpg
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