The axillary vein offers theoretical advantages for use in line cannulation. It is less likely to cause a pneumothorax and is more readily compressible than subclavian approaches. It has not been frequently used due to the lack of easily obtainable percutaneous landmarks to direct cannulation. We report the use of ultrasonographic guidance to direct axillary venous cannulation of triple lumen central venous catheters.
Bedside ultrasonographic guidance to locate and direct axillary venous cannulation was performed. The operator was highly experienced in the placement of central venous catheters. The size and depth of the vein was studied, number of attempts and complications were evaluated. All patients were hemodynamically stable and required central venous lines due to poor peripheral venous access.
Axillary vein cannulation was attempted in 12 patients and was successful in 8 (66%). In 2 patients the needle successfully entered the vein, but the guide wire could not be passed, while in 2 patients venous entry was not successful despite multiple attempts. In 3 of 4 patients that axillary cannulation failed, subclavian cannulation on the ipsiletaral side was successful. The average depth from the skin of the axillary vein was 2.73 cm and did not correlate with ability to cannulate. The average caliber of the axillary vein was 0.99 cm and did not correlate with successful cannulation. The procedure time decreased from 90 minutes to 25 minutes over the first 10 patients. There were 2 arterial punctures and no pneumothoraces for a total complication rate of 16.7%.
Axillary vein cannulation of central lines under sonographic guidance requires a significant operator learning curve. It is more time consuming than the subclavian approach and is associated with a high rate of arterial punctures and failure to achieve cannulation of the vein.
Axillary vein cannulation is technically difficult to perform, difficult to learn, and is associated with a relatively high rate of complications.
Harish Bhaskar, None.