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.

Persistent Left Superior Vena Cava in Pediatric Patients

2009 ◽  
Vol 10 (3) ◽  
pp. 219-220 ◽  
Author(s):  
Marco Caruselli ◽  
Gianmarco Piattellini ◽  
Gianfranco Camilletti ◽  
Roberto Giretti ◽  
Raffaella Pagni
Keyword(s):  
Superior Vena Cava ◽  
Pediatric Patients ◽  
Central Venous Catheterization ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Venous Catheterization

A persistent left superior vena cava (PLSVC) is a congenital anomaly of the systemic venous system. This anomaly is often discovered as an incidental result during central venous catheterization passing through the left subclavian or the left internal jugular vein. We report two cases of PLSVC in pediatric patients.

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 Incidentally Detected Asymptomatic Thrombus in the Inferior Vena Cava Thought to be Caused by Central Venous Catheterization for an Oral Surgical Procedure

2020 ◽  
pp. 1-2
Author(s):  
Shigeru Takuma ◽  
Shigeru Takuma ◽  
Yukifumi Kimura ◽  
Nobuhito Kamekura ◽  
Toshiaki Fujisawa
Keyword(s):  
Inferior Vena Cava ◽  
Surgical Procedure ◽  
Inferior Vena ◽  
Central Venous Catheterization ◽  
Vena Cava ◽  
Perioperative Period ◽  
Central Venous ◽  
Common Procedure ◽  
Venous Catheterization ◽  
Oral Surgical Procedure

Central venous catheterization (CVC) is a common procedure in the perioperative period, and thrombosis is one of the well-known complications of CVC. If the thrombus comes free from the vascular wall, it may cause serious problems such as pulmonary embolism. However, in some cases of inferior vena cava thrombosis, the patient has no symptoms, and thrombus is detected accidentally. A case in which asymptomatic thrombus in the inferior vena cava was incidentally detected following removal of the CV catheter after an oral surgical procedure is described.

scholarly journals Persistent Left Superior Vena Cava: A Finding After Central Venous Catheterization

2021 ◽  
Author(s):  
Francisco Lopes Morgado ◽  
Bárbara Saraiva ◽  
Celestina Blanco Torres ◽  
João Correia
Keyword(s):  
Superior Vena Cava ◽  
Central Venous Catheterization ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous ◽  
Left Superior Vena Cava ◽  
Anatomical Variant ◽  
Persistent Left Superior Vena ◽  
Venous Catheterization ◽  
Catheter Tip

Introduction: Persistence of the left superior vena cava (LSVC) is a rare anatomical variant in the general population with an estimated incidence of 0.3-0.5% in healthy individuals. Its diagnosis can be made incidentally after imaging control of central venous catheter (CVC) or other types of devices placements. Patient and Methods: We present the case of a patient with an acute disease which required central venous catheterization for the administration of intravenous chemotherapy. Results: Central venous catheterization proved difficult and after imaging control it revealed an unusual position of the catheter tip. Additional study to verify catheter tip position was performed and computed tomography (CT-scan) revealed the presence of a persistent left superior vena cava. The patient was then submitted to the planned treatment without any record of complications associated with CVC. Conclusion: Although uncommon the persistence of the LSVC can have an important impact in clinical practice, particularly when more invasive procedures are required. Its recognition is relevant in order to minimize the potential complications inherent to these procedures.

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.

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