Figure 1

Landmark infra-clavicular approach to cannulate subclavian vein. Infra-clavicular approach was used in landmark approach, with landmark points being the clavicle (the “break” or transition point, which is the junction of the medial one-third and lateral two-thirds of the clavicle) and the sternal notch. (a) The needle should pass below the clavicle and above the first rib, with appropriate point for cutaneous puncture being 1–2 cm below and laterally to the clavicular transition point. (b) The needle is advanced parallel to the floor, through the subclavian muscle, until it enter the subclavian vein.