Ultrasound-guided infraclavicular cannulation of the subclavian vein – still an ongoing misconception

Dear Editor,

With great interest we read the paper written by Davies and colleagues describing real-time ultrasound-guided (US-guided) cannulation of the subclavian vein, recently published online. ¹ Although the material is presented comprehensively, the subject matter of this paper is stated incorrectly.

In the paper, the authors describe the anatomy of the infraclavicular area using a detailed illustration. Astonishingly, thereafter they consistently use the term ‘subclavian vein’ instead of ‘axillary vein’. This is despite the fact that the illustrations in their paper and the description of the technique clearly indicate (as the authors admit in parenthesis) the procedure of the cannulation of the middle part of the axillary vein.

They argue that the described technique ‘is commonly referred to as subclavian vein cannulation in the published literature’. Unfortunately, the argument is unjustified and no wonder the authors did not give any reference. There are several papers regarding the use of US both in infraclavicular and in supraclavicular access to the subclavian vein.^2,3 Also, the US-guided infraclavicular approach to the axillary vein has recently been frequently studied. ⁴

The misconception regarding the terminology of the veins located in the infraclavicular area is not new and the issue was raised by the experts in the field. ⁵ By changing the terminology of respective blood vessels, Davies et al. clearly intensify this misconception.¹

In our opinion, the improper nomenclature of the veins situated in the infraclavicular area is a matter of essential importance and demands correction. It is not merely an issue of language, and there are three main consequences. Firstly, this misconception hampers the standardization of the procedure of the US-guided cannulation of the vein (subclavian and axillary vein, respectively). Secondly, interchangeably using the terms ‘subclavian’ and ‘axillary’ precludes comparing various approaches to the central veins. Thirdly, the paper is a review and thus potentially has an important educational function – by employing improper nomenclature, the authors diminish the cognitive value of their publication.