title: Real-time, ultrasound-guided infraclavicular axillary vein cannulation for renal replacement therapy in the critical care unit—A prospective intervention study.
abstract: OBJECTIVE
  The cannulation of the axillary vein for renal replacement therapy is a rarely performed procedure in the critical care unit. We defined the venipuncture and catheterization success rates and early mechanical complication rates of this technique in critical care patients with acute kidney injury.
  
  
  METHODS
  Twenty-nine mechanically ventilated patients with clinical indications for insertion of temporary hemodialysis catheters enrolled in a registered trial (NCT01919528) as a pilot cohort. We performed 29 real-time, ultrasound-guided infraclavicular axillary vein cannulation attempts for renal replacement therapy. We defined the venipuncture and catheterization success rates and early mechanical complication rates for this technique.
  
  
  RESULTS
  The puncture of the axillary vein was successful in 28 (96.5%) patients. In 22 patients (75.9%), venipuncture occurred during the first attempt and in 6 patients during the second (20.7%). The overall cannulation success rate was 93.1% (95% confidence interval, 77%-99%). We noted 6.8% potentially serious complications rate, 10.3% minor complications rate, and 0% life-threatening early mechanical complications. We achieved an 89.6% renal replacement therapy success rate and low rate of catheters malfunction.
  
  
  CONCLUSIONS
  Real-time, ultrasound-guided, infraclavicular axillary vein cannulation for renal replacement therapy in the critical care unit is a reliable method of dual-lumen hemodialysis catheter insertion and can be considered a reasonable alternative to jugular and femoral routes in special clinical circumstances.
authors.affiliation: Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland. Electronic address: tczarnik@mac.com.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Czarnik
authors.affiliation: Department of Anesthesiology and Critical Care, PS ZOZ Wojewodzkie Centrum Medyczne w Opolu, Aleja Witosa 26, 45-418 Opole, Poland.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Gawda
authors.affiliation: Department of Operations Research, Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Nowotarski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001367:Axillary Vein / Q000000981:diagnostic imaging*; D002405:Catheterization, Central Venous / Q000379:methods*; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000628:therapy*; D017582:Renal Replacement Therapy; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Acute kidney injury; Axillary vein; Catheterization; Critical care; Hemodiafiltration; Ultrasonography