Dear Editor,
We sincerely appreciate the technical report elucidating an open-door technique for ultrasound-guided subclavian vein cannulation.[1]
We wish to address certain aspects that warrant consideration. Our primary concern is the terminology describing the vein targeted by the reported technique. The subclavian vein lies under the clavicle and thus cannot be visualised through ultrasound. Instead, the visualised vein corresponds to the infraclavicular part of the axillary vein (IAV).[2] The technique should be aptly termed ‘infraclavicular axillary vein cannulation’.
The author’s attempt at IAV cannulation with a neutral arm position contradicts previous studies that have demonstrated that a neutral arm position is associated with reduced first-pass success rates and increased attempts at cannulation.[3] Conversely, arm abduction by 90° elevates the lateral end of the clavicle by 3.5 cm, exposing approximately 3 cm of the proximal IAV.[4] This medial segment of the IAV is larger and less collapsible, facilitating high first-pass success compared to the neutral arm position. Hence, we propose arm abduction as the optimal position for ultrasound-guided IAV cannulation.
Because infraclavicular axillary vein scanning and in-plane cannulation have already been described, this report presents a new nomenclature for an existing technique. Introducing the scanning method’s term “open door” could enhance its instructional value by offering a recognisable pattern for novice practitioners.
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Conflicts of interest
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REFERENCES
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