Anesth Analg 2004;99:562-565
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000130396.31225.E4
CRITICAL CARE AND TRAUMA
The Use of Ultrasound for Axillary Artery Catheterization Through Pectoral Muscles: A New Anterior Approach
NavParkash S. Sandhu, MD
Department of Anesthesiology, New York University School of Medicine, New York, New York
Address correspondence and reprints to NavParkash S. Sandhu, MD, Department of Anesthesiology, NYU School of Medicine, 550 First Ave., New York, NY 10016. Address e-mail to navparkashsandhu @hotmail.com.
A palpable axillary artery pulse is a prerequisite for introducing an arterial line. The close proximity of four nerves to the artery increases the chance of nerve injury, especially in anesthetized patients. The highly colonized entry site results in frequent infection. Approaching the axillary artery through the pectoral muscles by using real-time imaging should improve success, decrease infection, and prevent nerve and vessel injuries because these structures and the needle can be visualized directly. I describe three patients who had successful axillary lines placed through the pectoral muscles by using real-time sonography. The ability to see the artery, surrounding nerves, and vein and to observe the needle going through the tissues should increase safety and success, although a large study is needed to prove these hypotheses.
IMPLICATIONS: Axillary artery catheterization through the armpit is associated with nerve injuries and frequent infection. Our technique of introducing the catheter through the pectoral muscles by using real-time sonography allows imaging of the artery, the surrounding nerves, and the needle. This may increase both success and safety by decreasing nerve injuries and infection.
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