It is a superficial vein of the upper limb. Its name derives from «cephalic», which means head, since the vein runs to the shoulder.
The superficial venous network is the source of blood for most blood tests, and is the easiest place to access venous blood. In this article we will discuss the anatomy and clinical relevance of the cephalic vein.
Cephalic vein anatomy
The cephalic vein is a superficial vein in the hand, forearm, and arm. Between the superficial and deep networks of the veins, there are valves that reduce the likelihood of reflux from the deep venous system .
The cephalic vein drains the dorsal venous network of the hand that crosses the anatomical snuffbox, extends superficially to the radial styloid, and then ascends into the superficial fascia of the forearm.
The cephalic vein communicates with the basilic vein in the ulnar fossa through the median ulnar vein. At this point, the vein lies superficially in the lateral part of the elbow joint crease.
The cephalic vein now runs along the groove between the brachioradialis (flexor elbow and supinator of the forearm) and biceps brachii (supinator of the arm and flexor elbow) muscles.
The vein continues to rise in the superficial fascia anterolateral to the biceps brachii and superficial to the lateral cutaneous nerve of the forearm, which is a sensory branch of the musculocutaneous nerve (ventral branches of C5-7).
This innervates the muscles of the anterior compartment of the arm. The cephalic vein continues to rise in a groove between the pectoralis major and deltoid muscles. The deltoid branch of the thoracoacromial trunk accompanies the cephalic vein in this region.
It passes through the clavipectoral fascia and the axillary artery to drain into the axillary vein below the clavicle.
The axillary vein is renamed the subclavian vein once it passes the lateral border of the first rib, and the subclavian vein joins the internal jugular vein to form the brachiocephalic vein.
The thoracic duct drains the lymph from the lower limbs, these members where it mainly drains are:
- The abdomen.
- The left thorax.
- The left upper limb.
- The left side of the head.
- The neck.
- The angle between the left jugular vein.
- The subclavian vein on the left side.
Lymphatic drainage from the right upper extremity, the right chest, and the right side of the head and neck leads to the junction between the right subclavian vein and the internal jugular vein where they fuse.
These manage to form the right brachiocephalic vein. The two brachiocephalic veins join to form the superior vena cava that drains into the right atrium of the heart.
Clinical points of relevance
Cephalic vein cut
When a patient’s peripheral veins are too small or incompetent, central venous access or cutting of the cephalic vein may be necessary. This is traditionally done in the form of a central line in the subclavian vein.
However, the cephalic vein has presented an alternative where venous access is faster, easier and does not risk the complications of central venous access, that is, pneumothorax.
Other purposes of a cephalic vein reduction include percutaneous pacemaker lead placement in the heart and long-term venous catheter placement.
The Houseman’s Friend: Easily Accessible Veins
The junior doctor is usually in charge of obtaining the blood for blood tests.
The superficial veins of the upper limb are therefore the easiest place to access this blood and are therefore called “Houseman’s friend.”
The median ulnar vein in the ulnar fossa is the most commonly accessed vein.
Varicose veins are filled with tortuous superficial veins that result from the incompetence of the valves that separate the deep and superficial venous systems.
This results in an accumulation of venous blood in the superficial venous system.
Varicose veins of the upper limb are very rare, and the vast majority of patients have varicose veins of the lower limb.