The Venerable Subclavian Line


  • Nicholas Teman MD Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
  • Charles Hobson MD Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
  • Reid Tribble MD Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
  • Curt Tribble University of Virginia School of Medicine,Charlottesville,Virginia



Cardiac Surgery


In this treatise, we will address one of the higher-risk procedures, subclavian vein cannulation, that a practitioner may undertake in the care of complex patients. All cardiothoracic surgeons and their trainees will need, on occasion, to put in central lines in a variety of circumstances, including in the operating room, in the intensive care unit, in emergency circumstances, and, occasionally, when other practitioners have been unsuccessful in their attempts to place a central line.

We will describe, in detail, the anatomy of the subclavian vein, the preparation of the patient for subclavian vein cannulation, the infraclavicular approach to cannulation of the vein, and a few notes about the supraclavicular approach to the subclavian vein. It is self-evident that the priorities of central venous cannulation include safety of insertion, minimizing clot formation, and avoiding infection. We will dwell primarily on the principles of safe subclavian line insertion.


Buffett, W.

#:~:text=Risk%20comes%20from%20not%20knowing%20what%20you're%20doing (Accessed August 5, 2021)

Hester D. 2014. An Intern’s Recollection of a Night at the VA, July 2004. Chest 146(3): 871

Dudrick S. Steiger E, Wilmore D. 1969. Continuous Long-term Venous Catheterization: An Adjunct to Surgical Care and Study. Curr Top Surg Res. 1: 325-40.

Dudrick S. 2003. Early Development and Clinical Application of Total Parenteral Nutrition. J Parenteral and Enteral Nutrition. 27 (4): 291-9.

Patrick S, Tijunelis M, Johnson S, Herbert M. 2009. Supraclavicular Subclavian Vein Catheterization: The Forgotten Central Line. WestJEM 10: 110-4.

Honore P, Redant S, Preseau T. 2021. Use of peripherally inserted central catheters in ICU patients: We need to put in balance the important risks versus the potential advantages. J Crit Care. In Press.

Tubbs R. 2021. Anatomy is Destiny. Clinical Anatomy 34: 325.

Gretsky W. (Accessed August 5, 2021)

Tomar G, Chawla S, Ganguly S, Cherian G, Tiwari A. 2013. Supraclavicular approach of central venous catheter insertion in critical patients in emergency settings: Re-visited. Indian J Crit Care Med. 17(1): 10-15.

Tribble C, Julliard W. 2019. First, We Do Harm: Obtaining Informed Consent for Surgical Procedures. The Heart Surgery Forum 22(5): E423-8.

Goldratt, Eliyahu M. 1994. It’s Not Luck.

The North River Press. Great Barrington, MA (A novel written to explain The Theory of Constraints)

Tribble C. 2020. The Mental Strategies of Surgeons: A Primer, Part I. Heart Surgery Forum 23(6): 927-36.

Tribble C. 2021. The Mental Strategies of Surgeons: A Primer, Part II. Heart Surgery Forum 24(1): 201-208.

Waters D. 1995. A Heart Surgeon’s Little Instruction Book. Quality Medical Publishing, Inc. St. Louis, Missouri.

Video of donning gloves after gowning:

Mischke C, Verbeek J, Saarto A, Lavoie M, Pahwa M, Ijaz S. 2014. Gloves, extra gloves or special types of gloves for preventing percutaneous injuries in healthcare personnel. Cochrane Database Syst Rev. 7(3): CD009573.

Calland J, Guerlain S, Adams R, Tribble C, Foley E, Chekan E. 2002. A Systems Approach to Surgical Safety. Surg Endosc 16: 1005 – 14.

McPhee J. 1999. A Sense of Where You Are: A Profile of Bill Bradley at Princeton. Farrar, Straus and Giroux. New York.

Costello E. 1977. Allison. › Elvis-costello-alison-lyrics (Accessed August 5, 2021)

Tribble C. 2016. A Practical Minded Obsession with the Possibility and Consequence of Failure. Heart Surgery Forum Journal 19(1): 1-4.

Greene B. 2010. The Elegant Universe: Superstrings, Hidden Dimensions, and the Quest for the Ultimate Theory. W. W. Norton & Company. New York.

Tribble C, Merrill W. 2016. In Your Own Words: Toward a More Perfect Union of Patient Care and Education. Ann Thorac Surg 101: 837-40.

Hemingway E. (Accessed August 5, 2021)

Wichita Lineman. (Accessed August 5, 2021)



How to Cite

Teman, N., Hobson, C., Tribble, R., & Tribble, C. (2021). The Venerable Subclavian Line. The Heart Surgery Forum, 24(5), E925-E934.