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

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.

scholarly journals Ultrasound guided versus land mark technique for internal jugular central venous catheterization in cardiac surgical patients- a randomized trial

2016 ◽  
Vol 3 (1) ◽  
pp. 18-21 ◽  
Author(s):  
Santosh Sharma Parajuli ◽  
Jeju Nath Pokharel
Keyword(s):  
Internal Jugular Vein ◽  
Central Venous Catheterization ◽  
Jugular Vein ◽  
Venous Cannulation ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Successful Cannulation ◽  
Venous Catheterization ◽  
Complications Rate ◽  
Landmark Technique

Background: Catheterization of internal jugular vein can be achieved by either anatomical landmark technique or the ultrasound guided technique. The objective of our study is to find out if ultrasound guided technique could be beneficial in placing central venous catheters by improving the success rate by reducing the number of attempts, decreasing the access time and decreasing the complications rate in comparison to the landmark technique.Methods: Fifty patients scheduled for cardiac surgery requiring central venous cannulation of the right internal jugular vein were divided into two groups: ultrasound guided group ‘U’ and the landmark group ‘L’, each consisting of 25 patients with age more than 15 years. The outcomes were compared in terms of success rate, time taken for successful cannulation and rate of complications.Results: The two groups were comparable in terms of age, weight, heart rate and blood pressure. The mean number of attempts for successful cannulation was 1.08±0.277 and 1.40±0.764 (p=0.055), the time taken in seconds for successful cannulation was 108.56±27.822 and 132.08±72.529 (p=0.137) and the overall complication rate was 0% (0 out of 25) and 32% (8 out of 25) (p=0.02) in the ultrasound guided and the landmark technique group respectively.Conclusion: Ultrasound guided central venous catheterization of internal jugular vein is comparable to the landmark technique in terms of number of attempts and the time required for successful cannulation. Ultrasound guided technique is much safer than the landmark technique to reduce the overall complications rate during central venous cannulation.

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

2019 ◽  
Vol 21 (1) ◽  
pp. 66-72
Author(s):  
Boris Tufegdzic ◽  
Andrey Khozenko ◽  
Terrence Lee St John ◽  
Timothy R Spencer ◽  
Massimo Lamperti
Keyword(s):  
Mechanical Ventilation ◽  
Flow Velocity ◽  
Central Venous Catheterization ◽  
Elective Surgery ◽  
Statistical Significance ◽  
Axillary Vein ◽  
Mean Flow ◽  
Central Venous ◽  
Dynamic Variation ◽  
Venous Catheterization

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.

Percutaneous Catheterization of the Axillary Vein in Infants and Children

PEDIATRICS ◽  
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.

A New Device for Percutaneous Central Venous Catheterization

1989 ◽  
Vol 71 (5) ◽  
pp. 807-807 ◽  
Author(s):  
TOSHIYUKI ARAI ◽  
SHIN-ICHI NAKAO ◽  
KENJIRO MORI
Keyword(s):  
Central Venous Catheterization ◽  
Central Venous ◽  
New Device ◽  
Venous Catheterization

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

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

scholarly journals A Review of Various Techniques of Central Venous Catheter Insertion

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.

scholarly journals A Shallow Angle Short-Axis Out-of-Plane Approach Reduces the Rate of Posterior Wall Injuries in Central Venous Catheterization: A Simulation Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Kunitaro Watanabe ◽  
Joho Tokumine ◽  
Alan Kawarai Lefor ◽  
Akira Motoyasu ◽  
Kumi Moriyama ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Clinical Training ◽  
Central Venous Catheterization ◽  
Posterior Wall ◽  
Guidance System ◽  
Short Axis ◽  
Central Venous ◽  
Vein Wall ◽  
Venous Catheterization ◽  
Out Of Plane

The short-axis out-of-plane approach (SAX-OOP) is commonly used in ultrasound-guided internal jugular vein catheterization. However, this approach has a risk of posterior vein wall injuries. The authors hypothesized that a shallow angle of approach may reduce the rate of posterior wall injuries compared with the conventional steep angle approach. The present study aimed to evaluate whether a difference in the angle of approach of the needle affects the rate of posterior wall injuries. The present study was a randomized crossover-controlled trial involving 40 medical residents, conducted in the clinical training center at a hospital with a residency program. The primary outcome measure was the rate of posterior vessel wall injuries. Subjects received a didactic lecture during which the instructors taught three SAX-OOP techniques including the conventional free-hand method (procedure C), a needle navigation system (procedure N), and a shallow puncture angle using a guidance system (procedure S). Participants were trained in these approaches under supervision and each technique tested in a simulation environment. Thirty-four of 40 residents had no previous experience with central venous catheterization and were included in the final analysis. The rate of posterior vessel wall injuries in procedure S (9%) was significantly lower than using the other approaches (procedure C, 53%; procedure N, 41%). In conclusion, a shallow angle of approach using the SAX-OOP technique resulted in significantly fewer posterior vein wall injuries in central venous catheterization compared with steep angle techniques.

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