Dynamic variation of the axillary veins due to intrathoracic pressure changes: A prospective sonographic study

Introduction: The ultrasound-guided axillary vein is becoming a compulsory alternative vessel for central venous catheterization and the anatomical position offers several potential advantages over blind, subclavian vein techniques. Objective: To determine the degree of dynamic variation of the axillary vein size measured by ultrasound prior to the induction of general anesthesia and after starting controlled mechanical ventilation. Design: Prospective, observational study. Methods: One hundred ten patients undergoing elective surgery were enrolled and classified according to sex, age, and body mass index. Two-dimensional cross-sectional vein diameter, area, and mean flow velocity were performed using ultrasound on both the left and right axillary veins of each subject before and after induction of anesthesia. Results: There was statistically significant evidence showing that the axillary vein area increases when patients are mechanically ventilated. When considering venous flow velocity as a primary outcome, velocity decreased after patients moved from spontaneous to mechanical ventilation (coefficient = −0.267), but this relationship failed to achieve statistical significance ( t = –1.355, p = 0.179). Conclusions: Anatomical variations in depth and diameter as well as the collapsibility due to intrathoracic pressures changes represent common challenges that face clinicians during central venous catheterization of the axillary vein. A noteworthy increase in vessel size as patients transition from spontaneous to mechanical ventilation may theoretically improve first-pass cannulation success with practitioners skilled in both ultrasound and procedure. As a result, placing a centrally inserted central catheter after the induction of anesthesia may be beneficial.

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Axillary vein catheterization using ultrasound guidance: A prospective randomized cross-over controlled simulation comparing standard ultrasound and new needle-pilot device

The Journal of Vascular Access ◽

10.1177/11297298211063705 ◽

2021 ◽

pp. 112972982110637

Author(s):

Nicolas Boulet ◽

Xavier Bobbia ◽

Antoine Gavoille ◽

Benjamin Louart ◽

Jean Yves Lefrant ◽

...

Keyword(s):

Central Venous Catheterization ◽

Clinical Performance ◽

Posterior Wall ◽

Axillary Vein ◽

Central Venous ◽

New Device ◽

Successful Cannulation ◽

Us Guidance ◽

Venous Catheterization ◽

Vein Catheterization

Background: Real-time ultrasound (US) guidance facilitates central venous catheterization in intensive care unit (ICU). New magnetic needle-pilot devices could improve efficiency and safety of central venous catheterization. This simulation trial was aimed at comparing venipuncture with a new needle-pilot device to conventional US technique. Methods: In a prospective, randomized, simulation trial, 51 ICU physicians and residents cannulated the right axillary vein of a human torso mannequin with standard US guidance and with a needle-pilot system, in a randomized order. The primary outcome was the time from skin puncture to successful venous cannulation. The secondary outcomes were the number of skin punctures, the number of posterior wall puncture of the axillary vein, the number of arterial punctures, the number of needle redirections, the failure rate, and the operator comfort. Results: Time to successful cannulation was shorter with needle-pilot US-guided technique (22 s (interquartile range (IQR) = 16–42) vs 25 s (IQR = 19–128); median of difference (MOD) = −9 s (95%-confidence interval (CI) −5, −22), p < 0.001). The rates of skin punctures, posterior wall puncture of axillary vein, and needle redirections were also lower ( p < 0.01). Comfort was higher in needle-pilot US-guided group on a 11-points numeric scale (8 (IQR = 8–9) vs 6 (IQR = 6–8), p < 0.001). Conclusions: In a simulation model, US-guided axillary vein catheterization with a needle-pilot device was associated with a shorter time of successful cannulation and a decrease in numbers of skin punctures and complications. The results plea for investigating clinical performance of this new device.

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Percutaneous Catheterization of the Axillary Vein in Infants and Children

PEDIATRICS ◽

10.1542/peds.85.4.531 ◽

1990 ◽

Vol 85 (4) ◽

pp. 531-533

Author(s):

Richard I. Metz ◽

Steven E. Lucking ◽

Frank C. Chaten ◽

Thomas M. Williams ◽

John J. Mickell

Keyword(s):

Critically Ill ◽

Central Venous Catheterization ◽

Venous Pressure ◽

Vena Cava ◽

Infants And Children ◽

Venous Stasis ◽

Complication Rates ◽

Axillary Vein ◽

Central Venous ◽

Venous Catheterization

The axillary vein was evaluated as an alternative access site for central venous catheterization in critically ill infants and children. Children were placed in the Trendelenberg position (when possible) with arm abducted 100 to 130°. The vein was entered parallel and inferior to the artery. Success rate for catheterization was 79% (41/52). Catheter diameter range was 3 to 8.5 F and catheter length range was 5 to 30.5 cm. Median patient weight was 7.0 kg (3.0 to 59 kg). Median age was 0.91 years (14 days to 9 years). All central lines ended in the subclavian, innominate, or superior vena cava. Median catheter duration was 8 days (2 to 22 days). A total of 338 patient catheter-days were studied. Central venous pressure was successfully monitored in five of five attempts. Complications with insertion (3.8% of attempts) included one pneumothorax and one hematoma. Complications during catheter duration (9.8% of catheters, 1.1% per catheter-day) included one instance each of venous stasis, venous thrombosis, catheter sepsis, and parenteral nutrition infiltration. No complication contributed to a patient mortality. Success and complication rates were comparable with those in jugular catheterization studies in children. The axillary approach is an acceptable route for central venous catheterization in critically ill infants and children.

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A1006 VENOUS THROMBOSIS AFTER CENTRAL VENOUS CATHETERIZATION VIA THE AXILLARY VEIN (AV)

Anesthesiology ◽

10.1097/00000542-199009001-01004 ◽

1990 ◽

Vol 73 (3A) ◽

pp. NA-NA

Author(s):

C. Martin ◽

J. P. Auffray ◽

A. El Sayed Hassan ◽

P. Saux ◽

F. Gouln

Keyword(s):

Venous Thrombosis ◽

Central Venous Catheterization ◽

Axillary Vein ◽

Central Venous ◽

Venous Catheterization

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A Review of Various Techniques of Central Venous Catheter Insertion

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210735 ◽

2021 ◽

Vol 6 (3) ◽

pp. 204-207

Author(s):

Shallu Chaudhary ◽

Major Amit Atwal

Keyword(s):

Internal Jugular Vein ◽

Central Venous Catheterization ◽

Jugular Vein ◽

Standard Procedure ◽

Femoral Vein ◽

Seldinger Technique ◽

Axillary Vein ◽

Central Venous ◽

Venous Catheterization ◽

Landmark Technique

Central venous catheterization is a standard procedure used in the resuscitation of critically ill patients. There are different routes of CVP insertion which are:- subclavian vein, internal jugular vein, axillary vein and femoral vein. Each route has its own set of complications like artery puncture, pneumothorax, nerve injury, infections. Initially catheters were inserted by the landmark technique using guidewire through the needle commonly called seldinger technique. The landmark technique is found to be associated with a higher range of mechanical complications. The use of USG however has proved to improve the success rate and decrease the complications. Keywords: Central venous catheterization, resuscitation, internal jugular vein.

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Upper-extremity deep vein thrombosis after central venous catheterization via the axillary vein

Critical Care Medicine ◽

10.1097/00003246-199912000-00004 ◽

1999 ◽

Vol 27 (12) ◽

pp. 2626-2629 ◽

Cited By ~ 52

Author(s):

Claude Martin ◽

Xavier Viviand ◽

Pierre Saux ◽

François Gouin

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Central Venous Catheterization ◽

Axillary Vein ◽

Central Venous ◽

Vein Thrombosis ◽

Venous Catheterization ◽

Deep Vein

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Objective Assessment Metrics for Central Line Simulators: An Exploration of Causal Factors

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181320641487 ◽

2020 ◽

Vol 64 (1) ◽

pp. 2008-2012

Author(s):

Jessica M. Gonzalez-Vargas ◽

Dailen C. Brown ◽

Jason Z. Moore ◽

David C. Han ◽

Elizabeth H. Sinz ◽

...

Keyword(s):

Central Venous Catheterization ◽

Objective Assessment ◽

Central Line ◽

Expert Interviews ◽

Central Venous ◽

Patient Case ◽

Causal Factors ◽

Venous Catheterization ◽

Assessment Metrics ◽

Automated Feedback

The Dynamic Haptic Robotic Trainer (DHRT) was developed to minimize the up to 39% of adverse effects experienced by patients during Central Venous Catheterization (CVC) by standardizing CVC training, and provide automated assessments of performance. Specifically, this system was developed to replace manikin trainers that only simulate one patient anatomy and require a trained preceptor to evaluate the trainees’ performance. While the DHRT system provides automated feedback, the utility of this system with real-world scenarios and expertise has yet to be thoroughly investigated. Thus, the current study was developed to determine the validity of the current objective assessment metrics incorporated in the DHRT system through expert interviews. The main findings from this study are that experts do agree on perceptions of patient case difficulty, and that characterizations of patient case difficulty is based on anatomical characteristics, multiple needle insertions, and prior catheterization.

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