Real-time ultrasound-guided infraclavicular axillary vein cannulation: A prospective study in mechanically ventilated critically ill patients.

PURPOSE

The main purpose of this study was to define the venipuncture and catheterization success rates and early mechanical complication rates of ultrasound-guided infraclavicular axillary vein cannulation.

MATERIALS AND METHODS

We performed in-plane, real-time, ultrasound-guided infraclavicular axillary vein catheterizations under emergency and nonemergency conditions in mechanically ventilated, critically ill patients.

RESULTS

We performed 202 cannulation attempts. One hundred and twenty-six procedures (62.4%) were performed under emergency conditions. The puncture of the axillary vein was successful in 98.5% of patients, and the entire procedure success rate was 95.1% (95% confidence interval, 91.1%-97.6%). For the majority of patients (84.1%; P<.001, exact test), the venipuncture occurred during the first attempt. We noted a 22.4% overall complication rate, and most of the complications were malpositions (13.4%). We observed 8.5% of cases with potentially serious complications (puncture of the axillary artery and needle contact with the brachial plexus) and 1 case (0.5%) of pneumothorax. The puncture of the axillary artery occurred in 5 (2.5%) patients.

CONCLUSIONS

In-plane, real-time, ultrasound-guided, infraclavicular axillary vein cannulation in mechanically ventilated, critically ill patients is a safe and reliable method of central venous cannulation and can be considered to be a reasonable alternative to other central venous catheterization techniques.