Transpectoral ultrasound-guided catheterization of the axillary vein: An alternative to standard catheterization of the subclavian vein

Subclavian vein catheterization is associated with failure and complications because of injury to the nearby lung and subclavian artery. Its position, sandwiched between the clavicle and the first rib, makes sonographic imaging difficult. The medially pointed sonography probe makes it difficult to align the needle as well as image the entire needle. The axillary vein lies outside of the thoracic cage and can be easily imaged in its longitudinal view along with the entire needle, guidewire, dilator, and catheter in real-time. All described techniques of venous access using sonography have used transverse images of veins, and the needle is not completely visualized. Five cases of axillary vein catheterization using longitudinal section images of the vein, and following the needle, guidewire, and line with real-time sonography, are described. The use of longer puncture needles and introducer sheaths is suggested. A larger study is required to assess the potential of this technique.