Anatomical variations of the clavicle and main vascular structures in two pediatric patients : subclavicular vein cannulation with supraclavicular approach

Introduction Central venous catheterization (CVC) is implemented for volume resuscitation, hemodynamic monitoring, vasopressor administration, frequent blood sampling, parenteral nutritional support and the administration of long-term chemotherapy [1]. Generally, it is attempted using the internal jugular, subclavian or femoral veins. The subclavian vein access has been the recommended approach for CVC both for short and long term catheterization. The advantages of this approach can be attributed to the fact that it is a large vein [2,3]. The standard technique for placement of central venous catheters includes the use of anatomical landmarks which may not correlate with vessel location [3]. Although ultrasound guidance improved the success rate, reduced the number of needle passes and decreased complications associated with the internal jugular vein and CVC, it is currently uncommon for central venous catheter placement [1]. In this report, we present the use of a supraclavicular approach for subclavian cannulation with ultrasound guidance in two pediatric patients who had anatomical variations of the clavicles and main vascular structures due to cerebral palsy.