title: Real-time ultrasound-guided infraclavicular axillary vein cannulation: A prospective study in mechanically ventilated critically ill patients.
abstract: The main purpose of this study was to define the venipuncture and catheterization success rates and early mechanical complication rates of ultrasound-guided infraclavicular axillary vein cannulation.
  
  
  
  We performed in-plane, real-time, ultrasound-guided infraclavicular axillary vein catheterizations under emergency and nonemergency conditions in mechanically ventilated, critically ill patients.
  
  
  
  We performed 202 cannulation attempts. One hundred and twenty-six procedures (62.4%) were performed under emergency conditions. The puncture of the axillary vein was successful in 98.5% of patients, and the entire procedure success rate was 95.1% (95% confidence interval, 91.1%-97.6%). For the majority of patients (84.1%; P<.001, exact test), the venipuncture occurred during the first attempt. We noted a 22.4% overall complication rate, and most of the complications were malpositions (13.4%). We observed 8.5% of cases with potentially serious complications (puncture of the axillary artery and needle contact with the brachial plexus) and 1 case (0.5%) of pneumothorax. The puncture of the axillary artery occurred in 5 (2.5%) patients.
  
  
  
  In-plane, real-time, ultrasound-guided, infraclavicular axillary vein cannulation in mechanically ventilated, critically ill patients is a safe and reliable method of central venous cannulation and can be considered to be a reasonable alternative to other central venous catheterization techniques.
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: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001367:Axillary Vein; D002405:Catheterization, Central Venous / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011677:Punctures; D012121:Respiration, Artificial; D014463:Ultrasonography / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
keywords: Axillary vein; Central venous catheterization; Critical care; Ultrasonography