Infraclavicular access to the axillary vein — new possibilities for the catheterization of the central veins in the intensive care unit

Abstract

Central vein cannulation is one of the most commonly performed procedures in intensive care. Traditio nally, the jugular and subclavian vein are recommended as the first choice option. Nevertheless, these attempts are not always obtainable for critically ill patients. For this reason, the axillary vein seems to be a rational alternative approach. In this narrative review, we evaluate the usefulness of the infraclavicular access to the axillary vein. The existing evidence suggests that infraclavicular approach to the axillary vein is a reliable method of central vein catheterization, especially when performed with ultrasound guidance.

A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation by experienced operators

“…Over the past years, ultrasound guidance for central venous catheter has evolved from use of Doppler ultrasound alone to use of high frequency linear transducers (3,13,14). The high frequency linear transducers have detailed visualization of vessels.…”

“…Several studies document utility of ultrasound guidance for axillary vein cannulation with a decreased complication rate. Despite the development in the ultrasound guidance of axillary vein cannulation, most of the guidelines do not recommend the axillary method as routine (3,22). A larger study is required to assess the potential of this technique.…”

“…In many cases, such as obesity, thoracic deformity, and emergency status, the landmark method is a challenge and has a high incidence of complications (1,2). In the central line placement with the application of ultrasound, the puncture under direct vision, can significantly reduce complications, including pneumothorax, arterial injury and nerve damage, significantly improve patient safety (3)(4)(5). In previous studies, ultrasound method had a superior advantage in the jugular vein and femoral vein cannula compared to the landmark method (6,7).…”

Estimation of the head elevation angle that causes clinically important venous air embolism in a semi-sitting position for neurosurgery: a retrospective observational study

“…A positive end-expiratory pressure of 5 cmH 2 O was applied in all cases. A central venous catheter was inserted into the axillary vein with infraclavicular access in all patients 12) . The position of the tip of the central venous catheter was evaluated by saline flush and echocardiography 13) .…”

A systematic approach to ultrasound-guided central venous catheter placement—desirable modifications

“…The scheme created by the authors is similar to the one we recently published [ 4 ]. Unfortunately, their proposed systematic approach ignores several crucial steps in the procedure.…”