No abstract

Central venous lines are often used when there is difficulty obtaining peripheral venous access. The basilic and cephalic veins in the mid-arm region, although difficult to see or palpate, can be imaged longitudinally and cannulated using real-time ultrasonography, providing an easy alternative. These techniques are described, with reports of four typical cases.

Purpose Retrospective studies have associated perioperative regional anesthesia/analgesia during mastectomy for breast cancer with a decreased incidence of cancer recurrence. However, to date, no prospective data from a randomized, controlled trial has been reported. In a previous study we found that extending a single-injection paravertebral block with a multiple-day perineural local anesthetic infusion improves analgesia. This follow-up study investigates the rates of cancer recurrence for the single-injection and multiple-day infusion treatments. Methods Patients undergoing unilateral (n=24) or bilateral mastectomy (n=36) were included in the study. All had been diagnosed with breast cancer or tumor in situ, except for six patients who were receiving prophylactic bilateral mastectomy and were excluded from analyses. Patients received unilateral or bilateral single-injection thoracic paravertebral block(s) corresponding with their surgical site(s) with ropivacaine and perineural catheter(s). Subsequently, patients were randomized to receive either ropivacaine 0.4% (n=30) or normal saline (n=30) via their catheter(s) until catheter removal on postoperative day 3. Cancer recurrence from the date of surgery until at least 2 years post-surgery was investigated via chart review. Results Five of the 54 (9.2%) patients experienced a cancer recurrence following mastectomy: 3 of 26 (11.5%) of the patients with perineural ropivacaine and 2 of 28 (7.1%) of the patients with perineural saline. Conclusions This pilot study found no evidence that extending a single-injection paravertebral block with a multi-day perineural local anesthetic infusion decreases the risk post-mastectomy cancer recurrence. However, due to the small sample size of this investigation, further research is needed to draw definitive conclusions.

Marlex mesh with zipper was used for abdominal closure in 5 of 147 patients with generalized peritonitis seen during a period of 2 years. Residual/recurrent intra‐abdominal sepsis necessitating repeated explorations prompted use of this technique followed by frequent peritoneal lavages. Abdominal sepsis was successfully controlled in 4 of 5 patients, although we lost 3 of 5 patients due to multiple factors.

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.