Superficial venous system of upper limb

Superficial venous system of upper limb 

General features of superficial veins of upper limb

1.    The superficial veins lie in the superficial fascia

2.    The superficial vein have a tendency to run away from the pressure sites , so they are absent in the palm along the ulnar border of forearm and back of the elbow

3.     There are two main superficial veins one along the pre-axial border and the other along the post-axial border of the upper limb.

4.    Cephalic vein is the pre-axial vein which is longer than the post-axial basilic vein but basilic vein drain more blood from superior extremity

5.    Most of the blood of cephalic vein drain into the basilic vein through the median cubital vein

6.    Superficial veins are accompanied by cutaneous nerves and superficial lymphatics

Name of superficial veins of upper limb

1.    Dorsal venous arch

2.    Pre-axial cephalic vein

3.    Post –axial basilic vein

4.    Median cubital vein

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Dorsal venous arch

The dorsal venous network of the hand is a network of veins in the superficial fascia on the dorsum of hand formed by the dorsal metacarpal veins. 

It is included in the superficial venous system.

 It is an irregular arrangement of veins with transverse element which lies 2-3 cm proximal to the heads of metatarsal bones

Tributaries : three dorsal metatarsal veins

1.    A dorsal digital vein from the medial side of little finger

2.    A dorsal digital vein from the lateral side of index  finger

3.    Two dorsal digital veins of the thumb

4.    Veins draining palm of hand

a) veins that pass around the margins of the hand and

b) perforating veins which pass dorsally through the interosseous spaces

Function

1.    Its main function is the venous drainage of the hand.

2.    It not only receives blood from the palm around the borders of the hand, but also from veins that go through the interosseous spaces.

3.    In practical terms, this means that even when there is pressure on the palm from a gripping action, venous return does not slow.

4.    In addition, the cephalic and basilic veins come up from the dorsal venous arch. These are responsible for joining the deep veins and the lymphatics.

Drainage:

It drains into cephalic and basilica veins – the efferent vessels of dorsal venous arch  but most of the blood from the entire hand drains into the arch of the hand.

Cephalic vein

It begins as the continuation of lateral end of the dorsal venous arch

Course:

·         It crosses the roof of anatomical snuff box

·         Then it ascends on the radial border of the forearm , continues upwards in front of the elbow along the lateral border of the biceps

·         It pierces the deep fascia at the lower border of the pectoralis major , the deltopectoral groove up to the infraclavicular fossa

·         In the infraclavicular fossa , it pierces the clavipectoral fascia and drains into the axillary vein (deep vein of upper limb)

Clinical anatomy

·         It is routinely used for giving intravenous injections and for withdrawing blood from donors

·         The cephalic vein is preferred for hemodialysis in patients with chronic renal failure to remove waste products from blood

·         The cut down of cephalic vein in the deltopectoral groove is preferred when superior vena caval infusion is necessary

·         Cephalic vein is not preferred for cardiac catheterization due to the following reasons

1.    Its diameter does not increase as it ascends

2.    It joins the axillary vein at a right angle hence it is difficult ot maneuver the catheter around sharp cephaloaxillary angle

3.    In deltopectoral groove it frequently divides into small branches

4.    One of the branches ascends over the clavicle and joins the external jugular vein

Basilic vein

It is begins as the continuation of the medial end of the dorsal venous arch of the hand

Course :

·         It runs upwards along the back of the medial border of the forearm winds round this border near the elbow to reach the anterior aspect of the forearm

·         Then it continues upwards in front of the elbow along the medial side of the biceps brachii up to middle of the arm

·         At the middle of the arm it pierces deep fascia unites with the brachial veins and runs along the medial side of the brachial artery

·         Then it continued with axillary vein at the lower border of the teres major

Clinical anatomy

·         It is routinely used for giving intravenous injections and for withdrawing blood from donors

·         The basilic vein is preferred for cardiac catheterization for the following reason

·         The diameter of basilic vein increases as it ascends from cubital fossa to the axillary vein

·         It is in direct line with the axillary vein . to enter the right atrium the catheter passes in succession as follows

·         Basilic vein > axillary vein > subclavian vein > brachiocephalic vein > superior vena cava > right atrium of heart

Median cubital vein

It is the communicating venous channel between cephalic and basilica veins which shunts blood from cephalic vein to the basilic vein

Course

·         It begins from the cephalic vein 2.5 cm below the elbow bend runs obliquely upwards and medially to end in the basilica vein 2.5 cm above the bend of elbow

·         The important features of median cubital vein are as follows

·         It is separated from brachial artery by bicipital apneurosis

·         It communicates with the deep veins through a perforating vein which pierce the bicipital aponeurosis

·         It receives median vein of the forearm

·         It shunts blood from cephalic vein to basilic vein

Clinical anatomy

·         It is routinely used for giving intravenous injections and for withdrawing blood from donors

·         The median cubital vein is most preferred due to the following reasons

·         It is the most superficial vein of the body hence access is easy

·         It is well supported by the underlying bicipital aponeurosis

·         It is well anchored to the deep vein by a perforating vein hence it does not slip during procedure

Median vein of the forearm

It begins from palmar venous networks runs upwards in the midline on the anterior aspect of forearm to end in any one of three veins in front of elbow

Sometimes upper end of median vein of forearm bifurcates into median cephalic and basilic veins respectively

In this situation the median cubital vein is absent

Common venous patterns in front of the elbow

The veins in front of the elbow commonly form two patterns

1.    H shaped pattern

2.    M shaped pattern

·         Clinical anatomy

·          It is routinely used for giving intravenous injections and for withdrawing blood from donors

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