UMEM Educational Pearls

Title: Infraclavicular, Ultrasound-Guided Percutaneous Approach to the Axillary Artery for Arterial Catheter Placement: A Randomized Trial

Keywords: arterial cannulation, axillary artery, femoral artery, infraclavicular (PubMed Search)

Posted: 8/21/2023 by Quincy Tran, MD, PhD
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Settings: Single ICU in Poland, randomized trial

Participants: intubated patients who needed arterial catheter placement. Patients who had adequate access to one axillary and one femoral artery were eligible.

Patients were randomized 1:1 for axillary or femoral artery cannulation.

Outcome measurement: Primary outcome was cannulation success rate. Secondary outcomes were first pass success rate, number of attempts.

Study Results:

A total of 109 patients with data: 55 patients in the Axillary group vs. 54 for femoral group.
Cannulation success rate for axillary group was 96.4% vs. 96% for femoral group
First pass success rate for Axillary group was 69% vs. Femoral group of 74% (p=0.56)
Total number of procedural complications (puncture of opposite wall of artery, puncture of adjacent vein, periarterial extravasation, ischemia of extremity) was non-statistically different between groups.

Discussion:

There was higher rate of dysfunction of arterial pressure curve among Axillary group (15%) vs. femoral group (2%, P = 0.016). The reason for this finding is not quite clear.
Needle visibility was worse with the femoral group. There were 75% patients with excellent and good view for the Axillary group, vs. 24% for the femoral group. This could be due to the difference between out-of-plane cannulation for femoral group vs. in-plane cannulation for axillary group.
There was overall low rate of complications.

Conclusion:

Ultrasound-guided cannulation of the axillary artery via the infraclavicular route is non-inferior to the cannulation of the common femoral artery. When cannulation of the radial or femoral artery is not available, we can consider axillary artery via the infraclavicular approach.

References

Reference:

Gawda, Ryszard MD, PhD; Marszalski, Maciej MD; Piwoda, Maciej MD; Molsa, Maciej MD; Pietka, Marek MD; Filipiak, Kamil MD; Miechowicz, Izabela PhD; Czarnik, Tomasz MD, PhD1. Infraclavicular, Ultrasound-Guided Percutaneous Approach to the Axillary Artery for Arterial Catheter Placement: A Randomized Trial. Critical Care Medicine ():10.1097/CCM.0000000000006015, August 07, 2023. | DOI: 10.1097/CCM.0000000000006015