New anatomic landmarks for percutaneous catheterization of the internal jugular vein

The deltopectoral triangle as a landmark for percutaneous infraclavicular cannulation of the subclavian vein

An anatomic landmark is identified and described that simplifies the technique of central venous cannulation via the subclavian vein. The commonly used techniques are an approach to the subclavian at the junction of the medial and middle thirds of the clavicle or at the midclavicular line. A described anatomic landmark, the deltopectoral triangle, is easily identified in virtually all patients and requires no measuring or extensive knowledge of anatomy for localization. Penetration of the skin at this landmark facilitates the procedure and produces less patient discomfort. Using this technique, the authors have successfully cannulated the subclavian vein in 92.7% (51/55) of attempts with a 5.5% (3/55) complication rate. The only complications were arterial punctures, which were treated with pressure and were of no consequence to the patient.