Brachiocephalic vein, course, internal jugular vein, subclavian vein

2. Topic:
Veins of neck region
■ Subclavian vein
■ Internal jugular vein
■ Brachiocephalic vein
– presented by: Assigned by: Dr. Rameen
– Dr. Jannat Sohail
– Dr. Misbah Ramzan
– Dr. Nimra Imran

3. SUBCLAVIAN VEIN
Subclavian vein is a deep vein that moves oxygen-poor blood from
your upper body back to your heart
Course:
it is continuation of axillary vein
Beginning:
It begins at the outer border of the first rib
Termination:
Subclavian vein ends at the medial border of the scalenus anterior
muscle by joining the internal jugular vein to form the brachiocephalic
vein

4. Relation of subclavian vein
■ Posteriorly:
– Subclavian artery, scalenus anterior muscle, right
phrenic nerve.
■ Anteriorly:
– Clavical, subclavius
■ Inferiorly:
– 1st rib, pleura.

5. Tributaries of subclavian vein
■ Tributaries of subclavian vein is following:
– External jugular vein
– The dorsal scapular vein
– The thoracic dust on the left side
– The right lymphatic duct on the right side.

6. Clinical of subclavian vein
■ Subclavian vein thrombosis
– Subclavian/axillary vein thrombosis after
unaccustomed use of arm at shoulder joint.
– Causes
– Close relationship of clavicle and 1St rib-minor trauma
of these structure.
– Secondary complication of an indwelling venous
catheter

7. ■ Subclavian vein catheterization
– located in the lower anterior corner of
posterior triangle of neck. It lies
immediately posterior to medial 1/3 of
clavicle.
■ Approaches
1. Infraclavicular approach
– Infraclavicular approach is safer as the
vein lies close to the under surface of
medial 1/3 of clavicle
2. Supraclavicular approach
– The supraclavicular approach attempts to
cannulate the portion of the SCV just lateral to
the clavicular head of sternocleidomastoid
muscle

8. Internal jugular vein
■ Course
– It begins at the jugular foramen and ends
behind the sternal end of the clavicle by
joining the subclavian vein to form the
brachiocephalic vein
– Origin: origin marked by a dilation, the
superior bulb which lies in the jugular fossa
of the Temporal bone
– Termination: termination of the vein is
marked by the inferior bulb which lies
beneath the lesser supraclavicular fossa.

9. Relation of internal jugular vein
■ Superiorly
1. Sternocleidomastoid
2. Posterior belly of digastric
3. Superior belly of 0mohyoid
4. Parotid gland
5. Styloid process
6. Internal carotid artery, glossopharyngeal, vagus, accessory
and hypoglossal cranial nerve

10. ■ Posterior
1. transverse process of Atlas
2. Cervical plexus
3. Scalenus anterior
4. First part of subclavian artery
■ Medial
1. Internal carotid artery
2. Common carotid artery
3. Vagus nerve

11. Tributaries
■ Tributaries of IJV
– Inferior petrosal sinus
– Common facial vein
– Lingual vein
– Pharyngeal veins
– Superior thyroid vein
– Middle thyroid vein

12. Clinical
Jugular venous pressure
■ Define
– Jugular venous pressure is define as a distance Between the
midpoint of the right atrium and the palpable jugular venous
pulsation
■ JVP and jugular venous pulse are used as indirect measure of
cardiac function. Jugular veins are the most accessible connection
to the right side of heart.
■ JVP is used to examine the function of right atrium
■ Examiner palpates the internal jugular vein in order to determine
the location and quality of jugular venous pulse
■ The normal value of JVP is 6-8cm H2O(4.4 -5.8mmHg)
■ Value below the normal range usually indicates hypovolemia,
while the value higher than normal is a classic sign of venous
hypertension due to impaired cardiac filling

13. Brachiocephalic vein
■ Brachiocephalic vein is also known as innominate Vein
■ Beginning
– Brachiocephalic vein arising from the union of IJV and
subclavian vein, this union is commonly referred to as Venous
angle.
■ Drainage area
– Paired vein of the superior mediastinum that drains the venous
blood from the head, neck, upper limb and upper part of the
thorax.
■ Brachiocephalic vein has to two parts
– Right brachiocephalic vein ( approximately 2cm in length)
– Left brachiocephalic vein (approximately 6_8cm in length)

14. ■ Superior vena cava
– The Left and right brachiocephalic vein course towards the
midline and unite at the level of inferior border of 1st right costal
Cartilage to form the superior vena cava
■ Left brachiocephalic vein
– Relation
– Posteriorly: trachea, left phrenic nerve, left Vegas nerve, left
thoracic artery,3 major branches of arch of aorta
– Anteriorly
– Partially embedded in the thymus gland, separated from the
sternoclavicular joint by the sternohyoid and sternothyroid
muscle

15. ■ Tributaries of left brachiocephalic vein
– Vertebral
– Internal thoracic
– Inferior thyroid
– First posterior intercostal
– Left superior intercostal
– Thymic and pericardial veins

16. Right brachiocephalic vein
■ Course
– Obliquely downward and medially
– Formed anterior to the right pleura, phrenic nerve and internal
intercostal artery
■ Relation
– Anteriorolateral
– Brachiocephalic trunk, right vagus nerve
■ Tributaries of right brachiocephalic vein
– Vertebral
– Internal thoracic
– Inferior thyroid
– First posterior intercostal

17. Branches of brachiocephalic vein
■ Tympanic branch
– Courses through middle ear and gives secretomotor root to otic
ganglion.
■ Carotid branch for carotid body and carotid sinus.
■ Muscular for stylopharyngeus muscle
■ Carries taste from vallate papillae of tongue
■ Carries general sensation from posterior one third of tongue and palatine
tonsil.
■ Branch to pharyngeal plexus

19. Thank you