Abstract

Background: The cubital fossa is the commonest site of venous access, yet the vein selected lies within a compartment containing the brachial artery, the median nerve and two cutaneous nerves, whose disposition varies between individuals. Most anatomical studies describe venous patterns alone and do not quantify the proximity of the structures that determine procedural hazard. Methods: One hundred and eighty formalin-fixed limbs from 90 cadavers were dissected. The fossa was divided into equal medial, intermediate and lateral thirds. In each third the depth of the target vein, its separation from the brachial artery and median nerve, the structures lying within five millimetres of the projected puncture track, and the integrity of the bicipital aponeurosis were recorded. Arterial, neural and fascial variants were catalogued. Results: Separation of the vein from both artery and nerve increased progressively from medial to lateral. Major structures lay within five millimetres in 30.0% of medial thirds against 1.7% of lateral thirds. The lateral third nonetheless yielded the poorest venous availability and the highest exposure of the lateral antebrachial cutaneous nerve. Arterial variants were identified in a clinically material minority. Conclusion: The intermediate third offers the most favourable balance between venous accessibility and procedural safety. 

Keywords: Cubital fossa, Venous cannulation, Brachial artery, Superficial ulnar artery, Bicipital aponeurosis