Deltopectoral groove

The cephalic vein, a conunon venous access site for pacemaker implantation, drains directly into the axillary vein just superior to the pectoralis minor. The axillary vein is an excellent site for venous access, but is usually not considered because it is a rather deep structure. The surface landmarks of note are the infraclavicular space, deltopectoral groove, and the coracoid process. 

The needle is inserted at an angle of 45 degrees parallel to the deltopectoral groove, l-2cm medial (Figs. 4.21 and 4.22).If the vein is not entered, fluoroscopy is then used to define the first rib. The needle is advanced and touches the first rib. Sequential needle punctures are walked laterally and posteriorly until the vein is entered. It should be noted that one cannot palpate the axillary artery pulse and, thus, it is not a reliable landmark. The axillary artery and brachial plexus are usually much deeper and more posterior structures. This simple technique using basic anatomic landmarks of the... 

Fig. 4.20 A Incision carried down to the surface of the pectoralis major muscle and its orientation with respect to the deltopectoral groove noted. B Insert demonstrating the deltopectoral groove and orientation of the lateral border of the clavicular head of the pectoralis major. (From Belott PH. Blind axiUar venous access. Pacing Clin Electrophysiol 1999 22(7) 1085-1089, with permission.)...

Fig. 4.51 Deltopectoral groove subpectoral approach. The lateral border of the pectora-Us major clavicular head is gently retracted and a plane of dissection established medially behind the pectoralis major muscle. (From Belott PH, Reynolds DW. Permanent pacemaker and cardioverter defibrillation implantation. In Ellenbogen KA, Kay N, WUkoff BL, eds. Clinical cardiac pacing and defibrillation, 2nd ed. Philadelphia WB Saunders, 2(XX), with permission.)...

Reflecting the lateral clavicular head of the pectoralis major muscle creates the lateral submuscular approach. In this case, an initial vertical incision is made along the deltopectoral groove. The dissection is carried down to the snrface of the pectoralis fascia. The lateral border of the pectoralis major clavicnlar head is retracted medially and a subpectoralis major muscle plane of dissection established. 

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