Real-time Ultrasound-guided Axillary Vein Cannulation

The axillary vein has been shown to be a safe and effective cannulation site for patients requiring central venous access. Compared to subclavian vein cannulation, axillary vein cannulation may reduce the rate of pneumothorax and hemothorax. Long-term complications, including the rate of infection or deep vein thrombosis, are comparable to internal jugular vein cannulation. The use of ultrasound for cannulation at traditional central vein sites, such as the internal jugular and femoral veins has been shown to aid in successful cannulation and potentially reduce complications. For axillary vein cannulation, however, when ultrasound is used only for localization of the axillary vein precannulation, it has not been shown to improve successful cannulation or decrease the rate of arterial puncture. Real-time ultrasound-guided axillary vein cannulation has been described and may increase the rate of successful cannulation and decrease complications. Various techniques of real-time ultrasound-guided axillary vein cannulation have been studied over the past decade. They differ in various characteristics including technique for needle imaging (in-plane vs out-of-plane) and upper extremity positioning (neutral vs abducted). The in-plane technique, which images the axillary vein in longitudinal view and allows the needle to be visualized at all times, has been found to result in greater first-attempt success and easier overall placement than the transverse view technique. As for upper extremity positioning, 90° abduction may result a decreased risk of catheter misplacement after proximal axillary vein cannulation. Ultrasound-guided axillary vein cannulation has many emerging uses, including use in oncology, cardiology, and nephrology. How to cite this article Khatibi B, Sandhu NP. Real-time Ultrasound-guided Axillary Vein Cannulation. J Perioper Echocardiogr 2015;3(2):42-47.