Cadaveric Anatomical Study and Evaluation of The Coracoid Process as A Bony Landmark for Locating the Cephalic Vein

Objective: Clinicians require accurate anatomical information while gaining central venous access. The cephalic vein’s anatomical variations can make it challenging to locate. We asked if the coracoid process could be utilized as an accurate topographical landmark to locate the cephalic vein within 10 mm.

Methods: Bilateral shoulder dissections were conducted on 41 cadavers to determine the cephalic vein’s location in relation to the center of the coracoid process. Measurements were taken from the center of the coracoid process to the center of the cephalic vein. The cephalic veins were removed from the cadaver and the diameter obtained.

Results: Means of measurements relating to the coracoid process were: Straight line distance: 9.48 ± 4.45 mm, horizontal distance: 13.50 ± 6.45 mm, vertical distance: 11.03 ± 5.17 mm, and diameter: 1.59 ± 0.67 mm. A one sample student t-test on the straight-line distance, with the expected population mean set to 10 mm had a p-value = 0.0333906 and the test statistics was -1.860547. The mean diameter of the cephalic vein was 1.59 ± 0.67 mm. The mean depth of the cephalic vein was 13.53 ± 7.68 mm.

Conclusion: We showed that the cephalic vein is be located within 10 mm of the coracoid process with statistical significance. This study shows that if the clinician does not quickly locate the cephalic vein within 10 mm of the coracoid process, they can assume it is likely a variation or absent. This will aid clinicians in avoiding unnecessary time searching for the vein and instead rapidly transition to an alternative approach. With this new information, we hope to persuade more clinicians to make the cephalic vein cut down procedure their first and primary attempt for central venous access.

Keywords:Cephalic Vein Cut Down Procedure; Subclavian Puncture; Totally Implantable Venous Port Placement; Bony Anatomical Landmark; Coracoid Process; Vessel Diameter; Cadaveric Study; Clinical Decision Making

Abbreviations: CV: Cephalic vein; TIVAP: Totally implantable venous access port; SCP: Percutaneous subclavian puncture; CVCD: Cephalic Vein Cut Down; SD: Standard deviation; SWT: Shapiro-Wilk Test; CP: Coracoid process