Page 321 - Clinical Anatomy

ECA5 7/18/06 6:51 PM Page 306

306 The head and neck

Fig. 218◊The anatomy of
the infraclavicular
approach to the
subclavian vein. (a)
Anterior view. (b) In
sagittal section.

inner border of the anterior end of the first rib behind the clavicle. A reflux
of blood confirms venepuncture.
Subclavian venepuncture can be carried out most effectively by the infra-
clavicular approach (Fig. 218). The needle is inserted below the clavicle of
the junction of its medial and middle thirds. The needle is advanced medi-
ally and upwards behind the clavicle in the direction of the sternoclavicular
joint to puncture the subclavian vein at its junction with the internal
jugular. When a free flow of blood is obtained by syringe aspiration, a
radio-opaque plastic catheter is threaded through the needle to pass into
the brachiocephalic vein.

The lymph nodes of the neck

Although the lymph drainage of particular viscera is dealt with under
appropriate headings (tongue, larynx, etc.), it is convenient to summarize