• Andrea Farina, Guido Coppola, Giorgio Bassanelli, Alfredo Bianchi, Laura Lenatti, Luca A Ferri, Biagio Liccardo, Elena Spinelli, Stefano Savonitto, and Tommaso Mauri.
• Department of Cardiovascular Surgery, Alessandro Manzoni Hospital, Lecco, Italy - a.farina@asst-lecco.it.
• Minerva Anestesiol. 2020 Feb 1; 86 (2): 157-164.

BackgroundCentral venous catheterization is essential for careful administration of fluids and drugs in cardiac critical care patients. The axillary vein might represent an alternative to subclavian and jugular vein accesses, with the advantage of being extra-thoracic, more distal from the pleural space and with more likehood of comfort for the patient. Conventional ultrasound-guided cannulation of the axillary vein is technically demanding and does not guarantee precise visualization of the needle tip.MethodsWe describe a new in-plane technique with a dedicated bracket support for the needle, giving full tip control and continuous visualization of the tip and vessel, making the maneuver easier and safer. In a prospective observational study we also report the feasibility and safety of the novel procedure in a series of 35 cardiac critical care patients, also receiving non-invasive ventilatory support and/or being fully anti-coagulated.ResultsWith the novel technique, we obtained 97% success with procedural times comparable to other insertion sites and without complications.ConclusionsPlacement of a central line catheter in the axillary vein using a novel ultrasound-guided bracket-assisted technique may be a feasible, safe and rapid alternative to the conventional jugular and subclavian approaches.

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