A new extra-thoracic, in-plane, longitudinal, real-time, ultrasound-guided access to the axillary vein

  • Daniel AzoulayEmail author
  • Chady Salloum
  • Eylon Lahat
  • Rony Eshkenazi
  • Chetana Lim
What's New in Intensive Care


The Centers for Disease Control and prevention guidelines for the prevention of catheter-related bloodstream infections recommend using “a subclavian site, rather than an internal jugular or a femoral site, in adult patients” for central venous catheterization (CVC) [1]. However, this preferred approach, whether supra- or infra-clavicular, is hindered by the increased risk of mechanical complications, especially pneumothorax.

Ultrasound-guided CVC, in real-time rather than static imaging (indirect guidance), increases the venipuncture and cannulation safety and success rates.

Here, we describe a new technique to access the axillary vein, outside of the thoracic cavity, using in plane, real-time, ultrasound guidance in mechanically ventilated patients.


Before the procedure, the mechanically ventilated patient is placed in a neutral supine position with his/her head laying in the neutral position, and the left arm kept at 90° abduction and supination (Fig.  1a)....




Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

An approval by an ethics committee was not applicable.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Hepatobiliary and Pancreatic Surgery and Liver TransplantationHenri Mondor HospitalCréteilFrance
  2. 2.Department of General Surgery and Transplantation, Sheba Medical Center, Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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