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Anesth Analg 2004;99:183-187
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000117283.09234.2C

CRITICAL CARE AND TRAUMA

Transpectoral Ultrasound-Guided Catheterization of the Axillary Vein: An Alternative to Standard Catheterization of the Subclavian Vein

NavParkash S. Sandhu, MD

Department of Anesthesiology, New York University School of Medicine, New York, New York

Address correspondence and reprint requests to NavParkash S. Sandhu, MD, Department of Anesthesiology, NYU School of Medicine, 550 First Ave. New York, NY 10016. Address e-mail to navparkashsandhu{at}hotmail.com

Subclavian vein catheterization is associated with failure and complications because of injury to the nearby lung and subclavian artery. Its position, sandwiched between the clavicle and the first rib, makes sonographic imaging difficult. The medially pointed sonography probe makes it difficult to align the needle as well as image the entire needle. The axillary vein lies outside of the thoracic cage and can be easily imaged in its longitudinal view along with the entire needle, guidewire, dilator, and catheter in real-time. All described techniques of venous access using sonography have used transverse images of veins, and the needle is not completely visualized. Five cases of axillary vein catheterization using longitudinal section images of the vein, and following the needle, guidewire, and line with real-time sonography, are described. The use of longer puncture needles and introducer sheaths is suggested. A larger study is required to assess the potential of this technique.

IMPLICATIONS: Axillary vein catheterization using real-time sonography provides an image of a puncturing needle and axillary vein simultaneously, preventing lung, arterial, and nerve injury.




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T. Pirotte and F. Veyckemans
Ultrasound-guided subclavian vein cannulation in infants and children: a novel approach
Br. J. Anaesth., April 1, 2007; 98(4): 509 - 514.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.