Ultrasound Guided Out-of-Plane Versus In-Plane Transpectoral Left Axillary Vein Cannulation

Maddali, Madan Mohan; Arora, Nishant Ram; Chatterjee, Nilay

doi:10.1053/j.jvca.2017.02.011

Cited by 14 publications

(12 citation statements)

References 16 publications

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“…DAV cannulation boasts many of the same advantages as PAV cannulation, but the former technique is safer because of a greater distance between the vein and the accompanying artery or the pleural cavity. 4 Nevertheless, DAV collapse tends to be more severe than PAV collapse, with the DAV sometimes closing entirely during the inspiratory phase.…”

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confidence: 99%

Ultrasound-guided proximal versus distal axillary vein puncture in elderly patients: A randomized controlled trial

et al. 2020

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Background: Ultrasound-guided axillary vein catheterization is now widely used in hospital, but it remains uncertain whether the distal axillary vein approach is more beneficial for seniors than the proximal axillary vein approach. This study aims to compare the puncture success rate and anatomical characteristics between these two approaches. Methods: Senior patients requiring central venous catheterization were enrolled and randomized to the proximal axillary vein group ( n = 49) or the distal axillary vein group ( n = 50). Proximal axillary vein and distal axillary vein location time, venous depth, maximum diameter, and collapse index (defined as the percentage change in vein width caused by respiration) were recorded for all patients. The rate of puncture success and operation time were compared between groups. Results: Mean venous depth was 1.93 ± 0.45 cm for proximal axillary vein and 1.79 ± 0.46 cm for distal axillary vein ( p < 0.001). Maximum diameter was 0.80 ± 0.33 cm for proximal axillary vein and 0.61 ± 0.33 cm for distal axillary vein ( p < 0.001). Collapse indices were 20% ± 27% and 56% ± 34%, respectively ( p < 0.001). Also, location time was significantly shorter for proximal axillary vein than for distal axillary vein ( p < 0.001). One attempt and overall success rates were significantly higher in the proximal axillary vein group, compared with the distal axillary vein group (71.4% vs 42.0%, p = 0.003; 79.6% vs 54.0%, p = 0.007). Conclusion: For catheterization under ultrasound guidance in elderly patients, the proximal axillary vein approach is superior to the distal axillary vein approach.

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confidence: 99%

Ultrasound-guided proximal versus distal axillary vein puncture in elderly patients: A randomized controlled trial

et al. 2020

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“…No significant differences were observed. For populations with SCV catheterization 25 and axillary vein catheterization, 24 the SA-OOP approach showed a benefit.…”

Section: Resultsmentioning

confidence: 99%

Comparison between the long-axis/in-plane and short-axis/out-of-plane approaches for ultrasound-guided vascular catheterization: an updated meta-analysis and trial sequential analysis

Liu

Mao

Kang

et al. 2018

TCRM

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BackgroundA long-axis in-plane (LA-IP) approach and a short-axis out-of-plane (SA-OOP) approach are the two main approaches used in ultrasound (US)-guided vascular catheterization. However, the efficacy and safety of these approaches remain controversial. Therefore, we performed this meta-analysis to compare the two techniques in vascular catheterization.Materials and methodsRelevant studies were searched in PubMed, Embase, and the Cochrane Library databases from database inception until August 2017. Randomized controlled trials comparing a long-axis approach with a short-axis approach for US-guided vascular cannulation were selected. The RevMan software was used to analyze the results, and trial sequential analysis (TSA) was further applied to determine whether the currently available evidence was sufficient and conclusive.ResultsEleven studies met the inclusion criteria. Overall, 1,210 patients were included. The total success rate was similar between the SA-OOP and LA-IP approaches for US-guided vascular catheterization (risk ratio [RR], 1.01; 95% CI, 0.99–1.04; P=0.35; I2=48%). In the radial artery (RA; RR, 1.00; 95% CI, 0.96–1.05; P=0.88; I2=49%) and internal jugular vein (IJV; RR, 1.00; 95% CI, 0.98–1.02; P=0.99; I2=0%) subgroups, the total success rate was also similar and was confirmed by the TSA. For populations with subclavian vein (SCV) and axillary vein catheterization, the SA-OOP approach showed a benefit for first-attempt success rate. No significant differences in first-attempt success rate, cannulation times, or complications were found between the two approaches.ConclusionDespite a similar total success rate between the SA-OOP approach and the LA-IP approach when used for RA and IJV catheterization (as confirmed by TSA), further robust well-designed trials are warranted to evaluate other outcomes. There is insufficient evidence to definitively state that the SA-OOP approach was superior to the LA-IP approach when used for SCV and axillary vein catheterization. High-quality trials are needed to confirm or refute this finding.

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“…overall AV artery puncture was seen in four out of 43 patients using the same technique that was used in our study. [11] In this large analysis of US-guided central venous access, including 1644 cases of right AV venous and 279 cases of left AV cannulation where US-guided AV venous cannulation was performed for tunneled catheters, O’Leary et al . showed only 8 cases of axillary arterial injury (0.4%) and only three cases of pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of safety and efficacy of ultrasound-guided infra-clavicular axillary vein cannulation versus ultrasound-guided internal jugular vein cannulation in adult cardiac surgical patients

Shinde¹,

Jasapara²,

Bansode³

et al. 2019

Ann Card Anaesth

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Background: Ultrasound (US)-guided internal jugular vein (IJV) cannulation is a widely accepted standard procedure. The axillary vein (AV) in comparison to the subclavian vein is easily visualized, but its cannulation is not extensively studied in cardiac patients. Aims: This study is an attempt to study the efficacy of real-time US-guided axillary venous cannulation as a safe alternative for the time-tested US-guided IJV cannulation. Design: This is a prospective randomized controlled study. Materials and Methods: A total of 100 adult patients scheduled for cardiac surgery were divided equally in Group A-US-guided IJV cannulation, and Group B-US-guided axillary venous cannulation. Under local anesthesia and real-time US guidance the IJV or AV was secured. The access time, guidewire time, and procedure time were noted. Furthermore, the number of needle attempts, malposition, change of site, and complications were noted. Results: The data were analyzed for 49 patients in Group A and 48 patients in the Group B due to exclusions. The access time and the guidewire time were comparable in both groups. The first attempt needle puncture was successful for the IJV group in 98% of patients in comparison to 95% of patients in Group B. Guidewire was passed in the first attempt in 94% in Group A and 89% in the Group B. Except for arterial puncture in one case in group A, the complications were insignificant in both groups. Conclusion: The study shows that the US-guided AV cannulation may serve as an effective alternative to the IJV cannulation in cardiac surgery.

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Ultrasound Guided Out-of-Plane Versus In-Plane Transpectoral Left Axillary Vein Cannulation

Cited by 14 publications

References 16 publications

Ultrasound-guided proximal versus distal axillary vein puncture in elderly patients: A randomized controlled trial

Ultrasound-guided proximal versus distal axillary vein puncture in elderly patients: A randomized controlled trial

Comparison between the long-axis/in-plane and short-axis/out-of-plane approaches for ultrasound-guided vascular catheterization: an updated meta-analysis and trial sequential analysis

A comparative study of safety and efficacy of ultrasound-guided infra-clavicular axillary vein cannulation versus ultrasound-guided internal jugular vein cannulation in adult cardiac surgical patients

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