Real-time Multimodal Axillary Vein Imaging Enhances the Safety and Efficacy of Axillary Vein Catheterization in Neurosurgical Intensive Care Patients

Abstract

This series illustrates new and useful aspects of ultrasound use in transpectoral axillary vein catheterization: it requires minimal additional training; it combines the real time, in-plane technique with transverse, longitudinal, and Doppler color flow images; and it is used safely in the critically ill neurosurgical patient. The data on infraclavicular central venous catheters indicate decreased line sepsis, arterial punctures, and venous thrombosis while improving nursing care and patient comfort. This technique's potential for decreasing the risk of pneumothorax may make it a reasonable option for many critically ill patients in whom other central venous catheter approaches may not be ideal.

Real-time Ultrasound-guided Axillary Vein Cannulation

“…Real-time Ultrasound-guided Axillary Vein Cannulation JOPE the use of ultrasound for cannulation of other central veins has been found to aid in accurate cannulation and potentially reduce complications, 17,18 ultrasound used only for vein localization did not have these benefits. Cannulation failure rate was 14% 12 and rate of complications including arterial puncture remained. 7 Real-time needle ultrasound guidance may have avoided some of these complications.…”

“…Since the description of these two techniques, real-time ultrasound-guided axillary vein cannulation has been described in a wide range of patients. [11][12][13][14] The first reported case in which this technique was reproduced was in an emergency department patient who had septic shock and dementia. 11 The patient had difficulty remaining stationary for a traditional central venous cannulation.…”

“…9 Since then, it has been studied in a wide range of patients, including critically ill patients. [10][11][12][13][14] In this article, we will review axillary vein cannulation, including techniques for placement with real-time ultrasound-guidance, benefits, risks and emerging uses.…”

A manikin-based evaluation of a teaching modality for ultrasound-guided infraclavicular longitudinal in-plane axillary vein cannulation in comparison with ultrasound-guided internal jugular vein cannulation: A pilot study

“…[ 1 2 ] The benefits of this route compared to subclavian vein cannulation are the ability to provide direct external compression in the event of inadvertent arterial puncture, as well as a decreased risk of pneumothorax, hemothorax, and chylothorax. [ 1 2 ] AXV cannulation might benefit a selected subset of patients including those having neurosurgical procedures,[ 3 ] severe burns, or those have had a sternotomy or tracheostomy. Despite the potential benefits of this technique, many physicians are still unaware of this approach.…”

“…We have previously described a real-time multimodal AXV imaging and cannulation method using a combination of transverse and longitudinal images, venous compression views, and Doppler color flow. [ 3 ] In this pilot manikin study, we evaluated the efficacy of a teaching tool where an US-guided longitudinal AXV cannulation was compared with transverse internal jugular vein (IJV) cannulation technique between attending anesthesiologists and residents in training.…”