Anatomy of vessels for line insertion

The radial artery

• Origin: Division of brachial artery into radial and ulnar
• Course: Deep to brachioradialus, then beneath anatomical snuffbox into dorsal hand
• Termination: Anastamosis with ulnar artery \(\to\) deep palmar arch of hand

Supplies

• Lateral forearm muscles
• radial nerve
• carpal bones
• thumb
• lateral \(\frac{1}{2}\) 1st digit

Relationships at the wrist:

• Medial: Flexor carpi radialis \(\to\) palmaris longus \(\to\) median nerve
• Lateral: Brachioradialis tendon

The IJV

• Origin: inf. petrosal + sigmoid sinuses \(\to\) jugular bulb \(\to\) IVJ
• Course: skull \(\xrightarrow{\text{jugular foramen}}\) carotid sheath, deep to SCM \(\to\) joins subclavian to form brachiocephalic behind clavicle
• Right > Left

Relations

• @C2 carotid anterior
• @C3 carotid anteromedial
• @C4 carotid medial
• Also medial: CN IX X XI XII
• Posterior: cervical sympathetics
• Superficial: skin, fat, SCM, clavicle
• Inferior: pleura

Lateral to pulsatile carotid in Sedillot's triangle

• Inferior: clavicle
• medial: SCM; sternal head
• lateral: SCM; clavicular head

Tributaries ("Medical schools let fun people in")

• Middle thyroid
• Superior thyroid
• Lingual
• Facial
• Pharygneal
• Inferior petrosal + sigmoid sinuses

The subclavian vein

• Origin: continuation of axillary vein at lateral edge of 1st rib
• Course: Moves medially, over 1st rib and behind medial 3rd of clavicle
• Anterior to subclavian artery, seperated by anterior scalene
• Joins IJV behind medial edge of clavicle \(\to\) becomes brachiocephalic vein

Relations:

• Lateral: inferior trunk of brachial plexus, axillary vein
• Medial: trachea, vagal trunks, bracheocephalic vein, R lymphatic duct (right) / thoracic duct (left)
• Posterior: Anterior scalene, subclavian artery
• Anterior: medial 3rd clavicle
• Inferior: pleura, first rib
• Superior: skin, fat

Surface anatomy:

The femoral vein

• Origin: popliteal vein
• Becomes common femoral after union with deep femoral
• Becomes external iliac at inguinal ligament

The femoral artery

• Origin: External iliac artery at inguinal ligament
• Terminates when becomes popliteal artery at adductor hiatus

The femoral triangle

Borders:

• Superior: inguinal ligament runs between ASIS and pubic tubercle
• Lateral: medial edge of sartorius
• Medial: lateral edge of adductor longus
• Floor: iliopsoas fascia
• Ceiling: Skin, fat, fascia lata

Contents lateral \(\to\) medial at base of triangle (NAVEL)

• Femoral nerve
• Femoral artery
• Femoral vein
• Inguinal canal ('empty space')
• Lympatics
• At apex of triangle, femoral vein deep to artery

Landmarks:

• Femoral artery felt at mid-inguinal point (between ASIS and pubic symphysis), vein ~1cm medial

Preference for PICC insertion basilic > cephalic > deep brachial vein

Basilic: large, straight, has a shallow angle where it rejoins the brachials to form axillary vein

Cephalic: sharp angle at deltopectoral groove where it rejoins axillary v, often with a valve.

Deep brachial: run with median nerve and brachial artery, risk of damage to both. Much deeper.

Origin: Anterior tibial artery

Course: Crosses ankle joint \(\to\) plantar surface of foot just lateral to extensor hallucis longus, medial to extensor digitorum longus.

Termination: Division into 1st metatarsal a and deep plantar artery

Relations: Runs with deep peroneal nerve \(\to\) can be damaged