Subclavian vein cannulation

Place the child in the Trendelenburg position.
(A) Make a small incision at the junction of the medial and distal thirds of the clavicle. Insert the needle and direct it toward the posterior aspect of the sternal notch. Advance the needle along the inferior surface of the clavicle, in the horizontal plane of the chest. Blood will be easily aspirated when the needle enters the vein.
(B) Pass a guidewire through the needle. Remove the needle over the guidewire. Pass the catheter over the guidewire. Remove the guidewire. Confirm that blood can be aspirated from each port of the catheter, then flush it with saline. Secure the catheter with a suture and confirm tip placement.