MedEdPORTAL (Aug 2015)
“Open” Subclavian Vein Catheterization: Anatomy and Clinical Skills Learning Module
Abstract
Abstract Introduction A lack of anatomy knowledge is one of the main causes of complications associated with subclavian vein (SV) catheterization (SVC). This is because in clinical settings, the success of any blood vessel or cavity needle puncture is confirmed by obtaining the blood or liquid through the needle. The inability to confirm the correct position of the needle prevents the use of cadavers for teaching invasive clinical procedures. The American Association of Clinical Anatomists recommends incorporating several invasive procedures including SVC into a clinical anatomy curriculum of medical schools; however, no practical implementation guidelines have been provided. This module is designed to teach medical students anatomy and basic clinical skills that are required for successful SVC. Methods This module includes a description of the anatomy of the SV, a step-by-step guide to our newly developed dissection procedure, and a video of the “open” SVC. We named our procedure “open” because it can be performed under direct visual control. First, soft tissue of the infraclavicular region is carefully dissected and reflected to expose the axillary vein at the point where it is normally punctured during the SVC. Next, the needle is introduced through each of the soft tissue layers and a venous wall under visual control. Lastly, the procedure is repeated in a blind manner (with soft tissue flaps covering the axillary vein). Results We have been teaching common invasive clinical procedures to our first-year medical students during gross anatomy laboratory sessions for the past 3 years, and have begun to teach these procedures during our surgical anatomy elective course for fourth-year medical students. First-year medical students (n = 44) who were present during the lecture in anatomy were asked to participate in an anonymous survey. Seventy-seven percent of students responded to the survey, and 83% of student responders indicated that anatomy labs with clinical procedures are more beneficial than those without. Student surveys also indicated that implementation of clinical procedures into anatomy curriculum enhanced their motivation to learn anatomy by demonstrating the clinical relevance of the anatomy knowledge. Discussion This module is designed to teach medical students anatomy and basic clinical skills that are required for successful SVC. Such learning modules with instructional videos and quizzes may represent an efficient way to prepare students for anatomy labs with clinical components. They further facilitate integration of anatomical and clinical sciences by incorporating the teaching of clinical procedures into anatomy labs.
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