TIVAD implantation - general and visceral surgery

Demonstrating the anatomical relationship of the scalene muscle, subclavian/brachial artery and vein, and the relation of the clavicle regarding these two vessels.

Insert needle about 1 finger width inferior to the clavicle at roughly its middle and apply a total of 10 mL of local anesthetic, both as a wheal and in subclavian direction.

Puncture the vein with the needle initially at 70°-90° to the clavicle; after feeling no more resistance and with the needle definitely inferior to the clavicle, change the direction and advance the needle toward the (marked) suprasternal notch. Verify correct intraluminal placement by drawing venous blood into syringe.

Once intravenous access has been gained, insert the guidewire through the needle. Make a stab incision with a scalpel (no. 11) and then insert the dilator with the introducer.

Remove the guidewire and cover the introducer with a fingertip to prevent any air embolism (here not always illustrated adequately).

Remove the dilator while keeping the introducer in place.