From the Guidelines
Axillary arterial cannulation should be performed with ultrasound guidance to improve the success rate and diminish complications, as recommended by the guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients 1. To perform axillary cannulation, position the patient supine with the arm abducted to 90 degrees and externally rotated.
Key Steps:
- Identify the axillary artery pulse in the axilla, typically located lateral to the pectoralis minor muscle.
- After sterile preparation with chlorhexidine and local anesthesia (1-2 mL of 1-2% lidocaine), use a 20G catheter with ultrasound-guided technique.
- Visualize the artery in short-axis and use an in-plane approach.
- Once arterial blood return is obtained, advance the catheter over the needle, secure it with suture (typically 3-0 silk), and apply a sterile dressing. The axillary site offers advantages including good waveform fidelity, reduced risk of thrombosis compared to radial sites, and patient comfort as it allows arm mobility.
Important Considerations:
- Be aware of potential complications including hematoma, nerve injury (particularly to the brachial plexus), and thrombosis.
- Regular assessment of distal circulation is essential, and the line should be removed when no longer needed to minimize infection risk, as stated in the association of anaesthetists of great britain and ireland: safe vascular access 2016 guidelines 2.
- The use of ultrasound guidance is recommended for arterial cannulation, as it has been shown to improve the success rate and reduce complications, according to the guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients 3.
From the Research
Procedure for Axillary Artery Cannulation
The procedure for axillary artery cannulation involves several steps and considerations, including:
- Choosing between direct cannulation and cannulation via a side graft, depending on the diameter and elasticity of the vessel 4, 5
- Using ultrasound guidance to facilitate successful cannulation, especially in critically ill patients 6
- Selecting the appropriate cannulation site, with the left axillary artery being the most commonly used 7
- Considering the indications for axillary artery cannulation, including aortic root and arch surgery, type A aortic dissection, and porcelain aorta 8
Technical Considerations
Technical considerations for axillary artery cannulation include:
- The risk of vascular injury and dissection, which can be minimized by careful selection of the cannulation technique 4, 5
- The potential for technical problems, such as cannulation difficulties and insufficient perfusion, which can be mitigated by the use of ultrasound guidance and careful patient selection 5, 6
- The importance of operator experience and training in performing axillary artery cannulation 6
Indications and Contraindications
The indications for axillary artery cannulation include:
- Aortic root and arch surgery 8
- Type A aortic dissection 7, 8
- Porcelain aorta 8
- Re-operations of the thoracic aorta 8 Contraindications for axillary artery cannulation are not explicitly stated in the available evidence, but may include conditions that increase the risk of vascular injury or dissection, such as severe atherosclerosis or peripheral occlusive disease 4, 5