Ultrasound Guided Brachiocephalic Vein Cannulation using Supraclavicular Approach

The need of central vein cannulation has been increased since the increased case of critical patients and patients underwent high-risk patients. Supraclavicular approach of central vein cannulation is an alternative approach to central vein cannulation due to fewer anatomical variance, good longitudinal vein view, better visualization of needle during procedure, clear demarcation of landmarks, larger target area, better patient comfort, and fewer complications. This case study presents an ultrasound guided central vein cannulation using supraclavicular approach in 30 year old male patient diagnosed with septic shock, anemia, trombcytopenia, and electrolyte imbalance post laparotomy. The indication of central vein cannulation in the patient was to deliver volume resuscitation, to provide emergency vein access, to provide nutritional support, to deliver chemically caustic agents, and central vein pressure monitoring.

Strategies for appropriate positioning and repositioning the Avalon ECMO cannula in a 17-year-old with left hepatic vein malposition

Introduction Extracorporeal membrane oxygenation (ECMO) is a well-recognized therapy in children with refractory hypoxia. Different cannulas have been used with reported complications with placement, such as cardiac perforation, and multiple reports focusing on avoiding this. However, strategies to avoid hepatic vein cannulation and reposition when it occurs are not well described. Case report Here, we report a case where a 27-Fr Avalon bicaval double lumen cannula in the left hepatic vein was successfully repositioning using serial chest X-rays (CXR) and transthoracic echocardiography (TTE) in a 17-year-old female. Discussion While venovenous (VV) ECMO is preferred by many, placement of the Avalon catheter, a cannula available for VV ECMO, may be challenging due to migration or positioning issues. Specific techniques of wire and catheter advancement as well as confirming wire position in the infra-hepatic inferior vena cava can help ensure appropriate positioning while avoiding hepatic vein cannulation and enabling successful repositioning when it occurs. Conclusion Wire position in the infra-hepatic inferior vena cava helps ensure safe and appropriate Avalon cannula position and placement. The Avalon cannula can be successfully repositioned from the left hepatic vein by retracting the cannula, reinserting the wire and introducer together, and then manipulation techniques using serial CXR and TTE.

The Venerable Subclavian Line

In this treatise, we will address one of the higher-risk procedures, subclavian vein cannulation, that a practitioner may undertake in the care of complex patients. All cardiothoracic surgeons and their trainees will need, on occasion, to put in central lines in a variety of circumstances, including in the operating room, in the intensive care unit, in emergency circumstances, and, occasionally, when other practitioners have been unsuccessful in their attempts to place a central line. We will describe, in detail, the anatomy of the subclavian vein, the preparation of the patient for subclavian vein cannulation, the infraclavicular approach to cannulation of the vein, and a few notes about the supraclavicular approach to the subclavian vein. It is self-evident that the priorities of central venous cannulation include safety of insertion, minimizing clot formation, and avoiding infection. We will dwell primarily on the principles of safe subclavian line insertion.

Ultrasound Guided Brachiocephalic Vein Cannulation using Supraclavicular Approach

The need of central vein cannulation has been increased since the increased case of critical patients and patients underwent high-risk patients. Supraclavicular approach of central vein cannulation is an alternative approach to central vein cannulation due to fewer anatomical variance, good longitudinal vein view, better visualization of needle during procedure, clear demarcation of landmarks, larger target area, better patient comfort, and fewer complications. This case study presents an ultrasound guided central vein cannulation using supraclavicular approach in 30 year old male patient diagnosed with septic shock, anemia, trombcytopenia, and electrolyte imbalance post laparotomy. The indication of central vein cannulation in the patient was to deliver volume resuscitation, to provide emergency vein access, to provide nutritional support, to deliver chemically caustic agents, and central vein pressure monitoring.

Assessing ultrasound-guided axillary vein cannulation using a cumulative sum analysis: A single operator experience

Background: Ultrasound-guided axillary vein (AxV) cannulation has been described as an effective alternative to internal jugular vein cannulation in adult cardiac surgical patients. However, the learning curve for this technique has not yet been addressed. This study aimed to determine the number of cases required to achieve proficiency in performing AxV cannulation among novice anesthesiologists. Methods: This prospective study included the first 60 patients who underwent ultrasound-guided AxV cannulation performed by a single third-year resident who was trained in adult cardiac anesthesia. This study investigated the number of cases required to gain technical proficiency by applying cumulative sum analysis on the learning curve (LC-CUSUM) of ultrasound-guided AxV cannulation. Results: Based on the assessment of the CUSUM plots, a descending inflection point for decreasing the overall procedural time for AxV cannulation was observed after patient 29. Regarding the procedural outcomes, comparing the early-experience group with the late-experience group (29 vs 31 cases), the former group had longer operating time (1526 s vs 1120 s, p < 0.001) and identification time (110 s vs 92 s, p < 0.001) and lower first-attempt success rate (8, 27.6% vs 30, 96.8%, p < 0.001) than the latter group. Conclusions: CUSUM demonstrated that at least 29 successful cases are required to achieve an expertized manipulation in ultrasound-guided AxV cannulation for inexperienced novices. The learning curve for ultrasound-guided AxV cannulation was observed in 29 cases. After adequate training, the overall procedural time and the first-attempt success rate, and puncture-related complications for AxV cannulation improved with increased experience.

Comparing 1st Pass Success Rate and Number of Attempts for Internal Jugular Vein Cannulation by USG Guided Approach: Short Axis versus Long Axis Technique

The study was carried out in 80 patients admitted in ICU and OT at IGMC Shimla. Patients were divided into 2 groups:- group A (short axis) and group B(long axis) of 40 patients each. Internal jugular vein cannulation was done under USG guidance using the two techniques. We were successfully able to cannulate all the patients. We obtained vascular access with higher first pass success and less number of needle passes using short axis approach compared to long axis. Keywords: internal jugular vein cannulation, USG guided approach, short axis versus long axis technique, Central vein catheterization