Thus a precise stereotactic puncture of the terminal axillary
vein requires that the needle be elevated approximately 30 degrees from
the frontal plane of the body. Combined with the angle mandated by the course
of the vein in the frontal plane, the aiming point for the needle tip is
actually the body of the first thoracic vertebra at the posterior margin
of the superior thoracic aperture. If these criteria are followed, it is
essential that steady gentle suction be maintained and advancement be stopped
as soon as the front wall of the vein is punctured to avoid injuring deeper
structures. Using this anatomic approach, first puncture success has been
enhanced for the author and his students.
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