Brescia Fabrizio, Biasucci Daniele G, Fabiani Fabio, Favarato Michela, Costa Fabio, Longo Ferdinando, Martuscelli Matteo, Vitiello Michelangelo, Pittiruti Mauro
Unit of Anesthesia and Intensive Care Medicine and Vascular Access Team, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
Department of Intensive Care Medicine and Anesthesiology, "A. Gemelli" University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy.
J Vasc Access. 2019 Nov;20(6):763-768. doi: 10.1177/1129729819826034. Epub 2019 Jan 31.
Ultrasound-guided cannulation of the axillary vein in the infraclavicular area has several potential advantages for both short-term and long-term venous access devices. Currently, there are two techniques to approach axillary vein for ultrasound-guided cannulation: out-of-plane puncture in the short-axis view and the in-plane puncture in the long-axis view. We propose a novel ultrasound-guided puncture technique of axillary vein for centrally inserted central catheter placement, which consists in the oblique-axis view of the axillary vein coupled with the in-plane puncture. The main objectives of this study were feasibility and safety of this approach. The primary endpoints were the success rate and early complications; the secondary endpoints were late complications.
We analyzed data from a retrospective cohort of 80 ultrasound-guided cannulation of axillary vein performed with the oblique axis-in-plane technique in 80 cancer patients requiring a totally implantable central venous access, at CRO Aviano National Cancer Institute, during the period from January 2016 up to October 2017. We focused on the percentage of successful venous cannulation at the first attempt and on the cumulative incidence of early and late complications.
Axillary vein cannulation was successful at the first attempt in 77 out of 80 patients (96%). We had no significant complications during placement or in the first 48 h. The total number of catheter days was 27,432. The cumulative incidence of catheter-related bloodstream infection was of 0.036 per 1000 catheter days (only one case). We had no infection of the pocket of the reservoir, no symptomatic venous thrombosis, and no catheter migration.
Our data show that the oblique axis-in-plane technique of the ultrasound approach to the axillary vein is feasible and safe.
超声引导下在锁骨下区域进行腋静脉置管，对于短期和长期静脉通路装置都有若干潜在优势。目前，有两种超声引导下腋静脉置管的方法：短轴视图下的平面外穿刺和长轴视图下的平面内穿刺。我们提出一种用于中心静脉导管置入的新型超声引导下腋静脉穿刺技术，即腋静脉斜轴视图联合平面内穿刺。本研究的主要目的是评估该方法的可行性和安全性。主要终点是成功率和早期并发症；次要终点是晚期并发症。
我们分析了2016年1月至2017年10月期间，在阿维亚诺国家癌症研究所接受完全植入式中心静脉通路的80例癌症患者中，采用斜轴-平面内技术进行80次超声引导下腋静脉置管的回顾性队列数据。我们重点关注首次尝试静脉置管成功的百分比以及早期和晚期并发症的累积发生率。
80例患者中有77例（96%）首次尝试腋静脉置管成功。在置管过程中或最初48小时内未出现显著并发症。导管使用天数总计27432天。导管相关血流感染的累积发生率为每1000导管日0.036（仅1例）。未发生储液器囊袋感染、无症状性静脉血栓形成以及导管移位。
我们的数据表明，超声引导下腋静脉的斜轴-平面内技术是可行且安全的。
