Abstract
Background
Ultrasound (US) guided infraclavicular axillary vein (AXV) central venous catheterization is an emerging method for accessing central veins in critically ill patients. The efficacy and safety of the AXV catheterization remain unknown as compared to more commonly utilized central venous access sites.
Materials and methods
The main objective was to compare the efficacy and safety of US-guided AXV cannulation with those of other central venous access sites around the upper thoracic aperture region in critically ill patients. We performed a systematic review with meta-analysis. Three databases (PubMed, Web of Science and Scopus) were screened from inception until 1 July 2025 using a predefined search key and inclusion criteria (PROSPERO registration number CRD420251116432). The primary analysis included randomized controlled trials (RCTs) comparing AXV and internal jugular vein (IJV) cannulation. First-pass and overall success rate were evaluated as efficacy outcomes and mechanical complications (separately and cumulatively) as safety outcomes. Two researchers independently screened and extracted data using prespecified criteria. A random-effects inverse variance meta-analysis model was used. Risk of bias and grade of evidence were assessed using the ROB-2 tool and the GRADE approach, respectively.
Results
The primary analysis included 908 patients from three RCTs which examined US-guided AXV versus US-guided IJV cannulation. There were no significant differences in overall cannulation success rate (RR = 0.98 (99% CI: 0.95–1.02, p=.16, I2 = 28%)), high certainty) and there was a trend toward lower first pass success rate in the AXV group (RR = 0.93 (99% CI: 0.88-1.00, p=.008, I2 = 0%, high certainty)). This effect was negligible after alternative testing and evaluation of trail sequential analysis (TSA). We found no differences in terms of the cumulative mechanical complication rate (RR = 1.05, 95% CI: 0.69–1.61, p=.81, I2 = 0%, moderate certainty). The TSA revealed the equivalence of AXV to the IJV cannulation in terms of both efficacy and safety. The optimal information size for both aspects was achieved in the TSA.
Conclusions
In critically ill patients, US-guided infraclavicular AXV cannulation is equally effective and safe as US-guided IJV cannulation.
Review registration
This systematic review was registered prior its commencement in the PROSPERO database (CRD420251116432).
Supplementary Information
The online version contains supplementary material available at 10.1186/s13054-026-05869-2.
Keywords: Adult, Axillary vein, Central venous catheters, Catheterization, Catheters, Veins/diagnostic imaging Ultrasonography
Introduction
Before ultrasound guidance became standard practice, central venous cannulation was performed based on anatomical landmarks. The landmark-based approach to the internal jugular vein (IJV) was once commonly used as the preferred access site in critically ill patients. Compared with the cannulation of the subclavian vein (SCV), this approach appeared to have a higher success rate and a lower risk of mechanical complications [1, 2]. Currently, ultrasound guidance is recommended by the scientific guidelines to reduce early mechanical complications, increase overall success, and reduce catheter-related bloodstream infection (CRBSI) rate compared to landmark-based methods of central vein cannulation [1, 3–5].
The US-guided infraclavicular approach to the axillary vein (AXV) has recently gained increasing popularity in intensive care. This is because the AXV in the infraclavicular area is not covered by bony structures, so it is easily accessed for ultrasound examination [6]. The catheters inserted via the AXV share a common catheter skin exit site with the infraclavicular SCV access, which is characterized by the lowest rate of CRBSI and early thrombotic complication rates [3, 7–9].
Therefore, US-guided infraclavicular AXV cannulation can be a reasonable option for central venous catheter insertion in critically ill patients, potentially offering a high success rate and low complication rate. However, evidence remains limited regarding whether infraclavicular AXV cannulation is as efficacious and safe as cannulation of the IJV and SCV.
The main objective of this study was to assess whether US-guided infraclavicular AXV cannulation is equivalent to other central venous cannulation techniques in terms of efficacy and safety in critically ill patients. The study also entailed assessing the efficacy and safety of the proximal (PAXV) and distal (DAXV) infraclavicular approaches to the AXV.
Materials and methods
The study protocol of this systematic review with meta-analysis and trial sequential analysis (TSA) was registered in the PROSPERO database (registration number: CRD420251116432). The systematic search was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement [10]. The terminology used in this review complies with the NAVIGATE statement on the standard nomenclature in vascular access [11]. The study was not supported by any external or internal funding.
Database screening and data extraction
A systematic search of three databases (PubMed, Web of Science and Scopus) was performed from database inception to 1 July 2025 (Supplemental Digital Content – SDC). Eligible studies included published, full-text, English-language articles that evaluated axillary vein cannulation in at least one study arm. The results were deduplicated. Two independent reviewers screened the results by the study title and abstract (AK, ML). The full texts of the articles were retrieved and assessed for inclusion by two additional reviewers (RG, TC). The data from the included studies were extracted using standardised extraction forms by two authors (AK, ML). Any disagreements were resolved by discussion. In cases of persisting discrepancies, a third researcher was consulted (MZ). The screening process is depicted in the PRISMA flowchart (Supplemental Digital Content - SDC).
Study outcomes
The study outcomes were divided into two main groups: efficacy and safety.
The efficacy outcomes included overall cannulation success rate, time to successful cannulation, mean number of needle passes, and first pass success rate. The safety outcomes were the overall complication rate, arterial puncture, pneumothorax, hematoma at the puncture site, haemothorax or mediastinal hematoma, and catheter tip malposition.
Assumptions regarding the TSAs are included in SDC.
Planned analyses
The primary analysis was restricted to randomized controlled trials, which compared infraclavicular AXV cannulation with other central venous approaches located around the upper thoracic aperture region (IJV and SCV). The following sensitivity analyses were pre-specified: leave-one-out analysis, exclusion of high–risk-of-bias studies, inclusion of prospective observational studies when available, and application of a fixed-effect model. Additional exploratory analyses were also performed to compare cannulation of the AXV in the distal and proximal parts of the vein. To facilitate interpretation, DAXV and PAXV were used to refer to the distal and proximal segments of the axillary vein, respectively.
Bias and certainty of evidence
The quality and risk of bias were assessed by two investigators (TK, MZ) using the ROB-2 tool [12]. Grading of recommendations, assessment, development and evaluations (GRADE) of evidence was assessed by two authors (RG, TC) using GRADEpro software [13, 14].
Statistical analysis
The endpoints in the study groups were calculated and reported as counts and percentages for dichotomous variables and means with standard deviation for continuous variables. For performing meta-analysis, RevMan 5.4 was used, and forest plots were created for each analyzed domain (safety outcomes and efficacy) [15]. Random-effect models were utilized. Primarily, we used the DerSimonian-Liard (DL) method (Cochrane, RevMan). However, due to controversies regarding disproportionately large weights assigned to small trials by that model, we also used the Biggerstaff-Tweedie (BT) method which is available in the TSA software [16]. The BT method appears to mitigate the bias inferred by inappropriate random-effects model weighting [17]. Heterogeneity was assessed using the I2 test and Cochran’s Q test. The heterogeneity was deemed significant if Q was greater than the degrees of freedom and if the p value was below 0.05. The effect size was presented as relative risk (RR) with 95% or 99% CI or the mean difference (MD) with 95% or 99% CI. The TSA was utilized to validate the robustness of the results and to assess potential equivalence (non-inferiority and non-superiority) between study interventions (cannulation sites). Open access TSA software (0.9.5.10 Beta Version; Copenhagen Trial Unit’s TSA Software, Copenhagen, Denmark) was used [18, 19].
Results
This systematic search incorporated 1510 records, 14 of which were deemed eligible and comprised eight randomized controlled trials (RCTs) and six observational studies. The characteristics of RCTs are presented in Table 1. The outcomes extracted from the studies included in the primary analysis are available in the SDC (Table S1). Included studies enrolled ventilated and non-ventilated critically ill patients from intensive care units (ICUs), emergency departments (EDs), and cardiac surgery settings. In the majority of RCTs, the cannulation time and mean number of needle passes were not reported. All the RCTs included reported the predefined safety outcomes. The risk of bias assessment is presented in the SDC. The non-randomized studies which were identified in this review are summarized in Supplemental Table S2.
Table 1.
Summary of the randomised studies
| Author, year | Study design | Patient population and number of procedures | Ventiled patients | Reported outcomes | Operator expertise |
|---|---|---|---|---|---|
| Primary analysis: axillary vein vs. internal jugular vein | |||||
| Czarnik, 2023 [20] | Multicenter RCT |
ICU AXV (n = 306) IJV (n = 304) |
YES | Overall success rate, number of attempts, first pass success, mechanical complications, catheter misplacement | Minimum 10 procedures per approach |
| Fournil, 2023 [21] | Singlecenter RCT |
ICU and OR AXV (n = 101) IJV (n = 100) |
MIXED | Overall success rate, first pass success, mechanical complications, catheter misplacement | > 6 months experitise in US-guided cannulation |
| Shinde, 2019 [22] | Singlecenter RCT |
OR (elective CS) AXV (n = 48) IJV (49) |
NO | Overall success rate, number of attempts, first pass success, procedure time, mechanical complications, catheter misplacement | > 5 years experitise in US-guided cannulation |
| Secondary analyses: distal axillary vein vs. proximal axillary vein | |||||
| Buzançais, 2016 [25] | Singlecenter RCT |
ICU and OR DAXV (n = 60) PAXV (n = 62) |
MIXED | Overall success rate, number of attempts, first pass success, procedure time, mechanical complications, catheter misplacement | > 6 months experitise in US-guided cannulation |
| Su, 2020 [24] | Singlecenter RCT |
Cardiac surgery patients DAXV (n = 99) PAXV (n = 99) |
MIXED | Overall success rate, number of attempts, first pass success, procedure time, mechanical complications, catheter misplacement | 3 to 18 months of experience in US-guided AVC |
| Wang, 2020 [23] | Singlecenter RCT |
Geriatric patients DAXV (n = 50) PAXV (n = 49) |
NO | Overall success rate, number of attempts, first pass success, procedure time, mechanical complications, catheter misplacement | 3 year experience in the ICU |
| Other RCTs: out-of-plane vs. in-plane cannulation of AXV | |||||
| Ahn, 2015 | Singlecenter RCT |
General population Axillary vein: Arm abduction (n = 241) Neutral arm position (n = 240) |
Unknown | Overall success rate, procedure time, mechanical complications, catheter misplacement | > 12 months experitise in US-guided cannulation |
| Other RCTs: out-of-plane vs. in-plane cannulation of AXV | |||||
| Madalli, 2017 | Singlecenter RCT |
Cardiac surgery patients Axillary vein: Out-of-plane (n = 43) In-plane (n = 43) |
Unknown | Overall success rate, number of attempts, first pass success, procedure time, mechanical complications | Minimum 10 procedures per approach |
AXV – axillary vein, DAXV – distal axillary vein, IJV – internal jugular vein, ICU - intensive care unit, PAXV – proximal axillary vein, RCT – randomised controlled trial, US-guided – ultrasound-guided
Primary analysis
Three studies were included in the primary analysis, which included 908 patients [20–22]. All three studies compared AXV and IJV cannulation. An additional three studies comparing proximal and distal axillary access were not included, due to controversy regarding whether the proximal approach to the axillary vein is equivalent to subclavian vein access. Among the studies included, of the efficacy outcomes only overall success rate and first pass success rate were consistently found. All predefined safety outcomes were also reported. Figures 1 and 2 present the forest plots for overall cannulation success and first pass success, respectively. No differences in terms of overall cannulation efficacy were found (RR = 0.98 (99% CI: 0.95–1.02, p=.16, I2 = 28%)). The IJV group showed borderline-significant higher first pass success rate (RR = 0.93 (99% CI: 0.88–1.00.88.00, p=.008, I2 = 0%)).
Fig. 1.
Forrest plots of the overall cannulation success for AXV and IJV cannulation
Fig. 2.
Forrest plots of the first pass cannulation success for AXV and IJV cannulation
However, the effect for this outcome was non-significant in the alternative meta-analytic BT approach (SDC - Figure S1). Forest plots for the occurrence of arterial puncture, pneumothorax and the remaining outcomes are presented in the SDC, with no significant differences between access sites (Figures S2-S5). The overall risk of complications (cumulative pneumothorax, arterial puncture, hematoma at the puncture site, haemothorax, and catheter malposition) did not differ between the AXV and IJV cannulation sites (RR = 1.05, 95% CI: 0.69–1.61, p=.81, I2 = 0%)) – Fig. 3. There was no significant inter-study heterogeneity (quantified by Cochran’s Q test). The only source of heterogeneity arose from different study populations profiles.
Fig. 3.
Forrest plots of the overall complication rate for AXV and IJV cannulation
Equivalence testing for determining the efficacy and safety of axillary vein cannulation
The TSA was performed for first pass-success and overall complication rates for AXV and IJV, which are the most representative efficacy and safety outcomes.
The TSA graph for first-pass success (Fig. 4) demonstrates equivalence between the two approaches, suggesting that the effect identified by conventional analysis is non-significant. In Fig. 5 the TSA graph shows equivalence for both access sites in terms of overall complication rates. In both analyses, the required optimal information size was achieved.
Fig. 4.
Trial sequential analysis for first pass success for AXV and IJV cannulation
Fig. 5.
Trial sequential analysis for overall complications for AXV and IJV cannulation
Sensitivity analyses
Due to the lack of prospective comparative studies, the authors have only performed “leave-one-out” sensitivity analysis, which overlaps with excluding high risk-of-bias studies (overall three studies included). The results are presented in the SDC. The results regarding the efficacy and safety of AXV cannulation were consistent.
Secondary analyses
In this systematic review, the authors also identified three studies that evaluated the strategies of cannulation in the distal and proximal parts of the axillary vein [23–25]. The definition of distal access was not uniform across the studies – more extensive considerations are included in the SDC. There were no differences between these approaches regarding the chances of overall cannulation success (RR 0.89, 95% CI: 0.75–1.06, Z = 1.4, p=.19, I2 = 72%), first pass success (RR 0.77, 95% CI: 0.53–1.10, Z = 1.44, p=.15, I2 = 81%) or the cumulative risk of complications (RR 1.37, 95% CI: 0.45–4.20, Z = 0.55, p=.58, I2 = 62%). The inconsistency for all of these outcomes was substantial. The forest plots for these outcomes are available in Figures S6-S8. The TSA performed for first-pass success and overall complication rates revealed equivalence in terms of efficacy but was inconclusive for safety (complication risk). The TSA graphs are included in the SDC (Figures S9-S10).
Quality of evidence
Based on the TSA performed, both efficacy and safety of AXV compared with those of IJV cannulation. We concluded that the optimal information size had been reached for both outcomes. Therefore, we also assessed the certainty of this evidence (CoE). The assessment performed, using the GRADE approach, is available in SDC. The CoE for efficacy outcomes was high (for both overall success and first pass success rates), while for overall cannulation complications, the CoE was moderate.
Discussion
This meta-analysis revealed that infraclavicular AXV cannulation is equivalent to IJV cannulation in terms of access efficiency and safety. The performed analyses were robust, as the optimal information size had been achieved in both aspects, and the results were consistent across studies.
This study also compared the distal and proximal approaches to the AXV. The results suggest that both approaches are equally safe and efficient. However, the analyses failed to reach the optimal information size for safety outcomes and showed inconsistency, likely due to heterogeneity in study populations and differing proportions of mechanically ventilated patients. This warrants further studies to determine the safety of both approaches in terms of mechanical complications.
In the efficacy analysis, the rates for overall cannulation success were both very high and were 95% and 98% for AXV and IJV, respectively. However, the AXV cannulation tended towards lower first-pass success rates − 78% vs. 84%, respectively.
In classical testing this outcome reached significance, but the TSA revealed that the effect size was negligible (BT meta-analytic approach). Several prospective observational studies have reported first pass success rate ranging from 70% up to 100% [26–28]. The first pass success rate during AXV cannulation may vary according to the puncture site, with low first pass success in the distal portion of the axillary vein at 42% [23]. In the studies conducted by Wang and Su, the lower first pass success rates were inversely correlated with the respiratory collapsibility index of the distal AXV [23, 24].
In recent guidelines, SCV has been recommended as a preferential central venous access because of its lower CRBSI and venous thrombosis rates, and safety comparable to the IJV access in terms of early mechanical complications [1, 7–9]. Although the axillary and subclavian veins are separate venous access routes, their common feature is the exit point of the catheter on the skin in the infraclavicular region, which is associated with reduced CRBSI risk.
In the literature there is some confusion in the nomenclature describing these two vessels [6]. The subclavian vein becomes the axillary vein on the lateral border of the first rib, thus in the majority of cases it is beyond the reach of ultrasound. Therefore, the majority of studies that have investigated US-guided infraclavicular cannulation of the SCV have, in fact, examined AXV cannulations.
For the sake of data synthesis, many authors tend to treat AXV and SCV interchangeably, which is reflected in recent guidelines from the American Society of Echocardiography [3]. Therefore, the data on thrombosis and CRBSI reduction risk in SCV cannulations might be translatable to the AXV cannulations but, to the best of our knowledge, this problem has never been examined.
An important aspect of using the infraclavicular approach to the AXV as a preferential access site for centrally inserted central venous catheter placement in intensive care is the potential to spare the right IJV (RIJV) access. The RIJV has been suggested and recommended by the Swedish Society of Anaesthesiology guidelines, as the most convenient access site for the insertion of large-bore devices, such as dialysis catheters, pulmonary artery catheters, and venous cannulae for extracorporeal membrane oxygenation [29]. Lastly, the authors also underline the need to adjust catheter length when using distal axillary access, especially on the left patient side. Using a shorter than 20 cm catheter will increase the risk of chemically-induced endothelial damage, increasing the thrombosis risk due to an incorrectly positioned (high) catheter tip - often in the brachiocephalic vein or upper portion of the superior vena cava [30].
Limitations
This study only compared axillary vein versus internal jugular vein cannulation. This is due to inconsistency in the scientific literature regarding the distinction between the subclavian and axillary veins. Second, there was some inter-study heterogeneity due to different patient profiles included in the analysed studies. Third, the optimal information size for the secondary analysis was not achieved and therefore the optimal site of AXV cannulation requires further study. Lastly, the endpoints in the primary analysis did not include catheter-associated infections and thrombosis, because few studies have focused exclusively on the axillary vein.
Conclusions
Among critically ill patients, AXV cannulation demonstrates comparable efficacy and safety to IJV access. Considering lower CRSBI rates in patients with catheters placed in the infraclavicular region than in the IJV, AXV and SCV may be treated as a first-line central venous access site. The proximal and distal approaches to the AXV are equally effective, however, more studies are needed to assess their safety. Future research should focus on determining the optimal portion of axillary vein for catheter placement.
Supplementary Information
Acknowledgements
Not applicable.
Author contributions
TK – conceptualization, methodology, formal analysis, data curation, writing of the original draft. MZ - conceptualization, formal analysis, data curation, manuscript drafting. ML - formal analysis, data curation, manuscript drafting. AK - formal analysis, data curation, manuscript drafting. RG – conceptualization, formal analysis, data curation, writing of the original draft, manuscript drafting. TC - conceptualization, formal analysis, data curation, writing of the original draft, manuscript drafting.
Funding
The study was not supported by any external or internal funding source.
Data availability
All necessary data for replication of these finding is available in Supplemental Digital Content and in the PROSPERO record.
Declarations
Ethics approval and consent to participate
The study is a systematic review, and thus IRB/IEB committee approval was not required.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Timsit JF, Baleine J, Bernard L, Calvino-Gunther S, Darmon M, Dellamonica J, et al. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care. 2020;10(1):118. 10.1186/s13613-020-00713-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Adrian M, Borgquist O, Kröger T, Linné E, Bentzer P, Spångfors M, et al. Mechanical complications after central venous catheterisation in the ultrasound-guided era: a prospective multicentre cohort study. Br J Anaesth. 2022;129:843–50. 10.1016/j.bja.2022.08.036. [DOI] [PubMed] [Google Scholar]
- 3.Vegas A, Wells B, Braum P, Denault A, Miller Hance WC, Kaufman C, et al. Guidelines for performing ultrasound-guided vascular cannulation: recommendations of the American Society of Echocardiography. J Am Soc Echocardiogr. 2025;38:57–91. 10.1016/j.echo.2024.12.004. [DOI] [PubMed] [Google Scholar]
- 4.Lamperti M, Biasucci DG, DIsma N, Pittiruti M, Breschan C, Vailati D, et al. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol. 2020;37(5):344–76. 10.1097/EJA.0000000000001180. [DOI] [PubMed] [Google Scholar]
- 5.Boulet N, Pensier J, Occean BV, Peray PF, Mimoz O, Rickard CM, et al. Central venous catheter-related infections: a systematic review, meta-analysis, trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion. Crit Care. 2024;28:387. 10.1186/s13054-024-05162-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Annetta MG, Spencer TR, Pittiruti M. The never-ending confusion between subclavian vein and axillary vein. J Vasc Access. 2025;11297298251352477. 10.1177/11297298251352477. [DOI] [PubMed]
- 7.Parienti J-J, Mongardon N, Mégarbane B, Mira J-P, Kalfon P, Gros A, et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015;373:1220–9. 10.1056/nejmoa1500964. [DOI] [PubMed] [Google Scholar]
- 8.Wu C, Zhang M, Gu W, Wang C, Zheng X, Zhang J, et al. Daily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: a prospective multicenter study. Intensive Care Med. 2023;49:401–10. 10.1007/s00134-023-07006-x. [DOI] [PubMed] [Google Scholar]
- 9.O’Grady NP, Alexander M, Burns LA, Patchen Dellinger E, Garland J, Heard SO et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011). 10.1093/cid/cir138
- 10.Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. 10.1136/bmj.n160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.van Rens M, van der Lee R, Spencer TR, van Boxtel T, Barone G, Crocoli A, et al. The NAVIGATE project: A GloVANet–WoCoVA position statement on the nomenclature for vascular access devices. J Vasc Access. 2025;26(5):1439–46. 10.1177/11297298241291248. [DOI] [PubMed] [Google Scholar]
- 12.Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. 10.1136/bmj.l4898. [DOI] [PubMed] [Google Scholar]
- 13.Schünemann H, BJGGOA, editor. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group; 2013.
- 14.GRADEpro GDT. GRADEpro guideline development tool [Software]. McMaster University and Evidence Prime; 2023.
- 15.Review Manager (RevMan). [Computer program]. Version 5.4. The Cochrane Collaboration, 2020.
- 16.Brockwell SE, Gordon IR. A comparison of statistical methods for meta-analysis. Stat Med. 2001;20:825–40. 10.1002/sim.650. [DOI] [PubMed] [Google Scholar]
- 17.Biggerstaff BJ, Tweedie RL. Incorporating variability in estimates of heterogeneity in the random effects model in meta-analysis. Stat Med. 1997;16:753–68. [DOI] [PubMed]
- 18.Afshari A, Wetterslev J. When may systematic reviews and meta-analyses be considered reliable? Eur J Anaesthesiol. 2015;32(2):85–7. 10.1097/EJA.0000000000000186. [DOI] [PubMed] [Google Scholar]
- 19.Thorlund K, Devereaux PJ, Wetterslev J, Guyatt G, Ioannidis JPA, Thabane L, et al. Can trial sequential monitoring boundaries reduce spurious inferences from meta-analyses? Int J Epidemiol. 2009;38:276–86. 10.1093/ije/dyn179. [DOI] [PubMed] [Google Scholar]
- 20.Czarnik T, Czuczwar M, Borys M, Chrzan O, Filipiak K, Maj M, et al. Ultrasound-Guided infraclavicular axillary vein versus internal jugular vein cannulation in critically ill mechanically ventilated patients: A randomized trial. Crit Care Med. 2023;51:E37–44. 10.1097/CCM.0000000000005740. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Fournil C, Boulet N, Bastide S, Louart B, Ambert A, Boutin C, et al. High success rates of ultrasound-guided distal internal jugular vein and axillary vein approaches for central venous catheterization: a randomized controlled open-label pilot trial. J Clin Ultrasound. 2023;51:158–66. 10.1002/jcu.23383. [DOI] [PubMed] [Google Scholar]
- 22.Shinde P, Jasapara A, Bansode K, Bunage R, Mulay A, Shetty V. A comparative study of safety and efficacy of ultrasound-guided infra-clavicular axillary vein cannulation versus ultrasound-guided internal jugular vein cannulation in adult cardiac surgical patients. Ann Card Anaesth. 2019;22:177–86. 10.4103/aca.ACA_24_18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Wang HY, Sheng RM, Gao YD, Wang XM, Zhao WB. Ultrasound-guided proximal versus distal axillary vein puncture in elderly patients: a randomized controlled trial. J Vasc Access. 2020;21:854–60. 10.1177/1129729820904866. [DOI] [PubMed] [Google Scholar]
- 24.Su Y, Hou J, Ma G, Hao G, Luo J, Yu S, et al. Comparison of the proximal and distal approaches for axillary vein catheterization under ultrasound guidance (PANDA) in cardiac surgery patients susceptible to bleeding: a randomized controlled trial. Ann Intensive Care. 2020;10:90. 10.1186/s13613-020-00703-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Buzançais G, Roger C, Bastide S, Jeannes P, Lefrant JY, Muller L. Comparison of two ultrasound guided approaches for axillary vein catheterization: a randomized controlled non-inferiority trial. Br J Anaesth. 2016;116:215–22. 10.1093/bja/aev458. [DOI] [PubMed] [Google Scholar]
- 26.Czarnik T, Gawda R, Nowotarski J. Real-time ultrasound-guided infraclavicular axillary vein cannulation: a prospective study in mechanically ventilated critically ill patients. J Crit Care. 2016;33:32–7. 10.1016/j.jcrc.2016.02.021. [DOI] [PubMed] [Google Scholar]
- 27.Farina A, Coppola G, Bassanelli G, Bianchi A, Lenatti L, Ferri LA, et al. Ultrasound-guided central venous catheter placement through the axillary vein in cardiac critical care patients: safety and feasibility of a novel technique in a prospective observational study. Minerva Anestesiol. 2020;86:157–64. 10.23736/S0375-9393.19.13670-X. [DOI] [PubMed] [Google Scholar]
- 28.Glen H, Lang I, Christie L. Infraclavicular axillary vein cannulation using ultrasound in ventilated patients infraclavicular axillary vein cannulation using ultrasound in a mechanically ventilated general intensive care population. Anaesth Intensive Care. 2015;45:5. 10.1177/0310057X1504300513. [DOI] [PubMed] [Google Scholar]
- 29.Frykholm P, Pikwer A, Hammarskjöld F, Larsson AT, Lindgren S, Lindwall R, et al. Clinical guidelines on central venous catheterisation: central venous catheterisation. Acta Anaesthesiol Scand. 2014;58(5):508–24. 10.1111/aas.12295. [DOI] [PubMed] [Google Scholar]
- 30.Walshe C, Phelan D, Bourke J, Buggy D. Vascular erosion by central venous catheters used for total parenteral nutrition. Intensive Care Med. 2007;33:534–7. 10.1007/s00134-006-0507-9. [DOI] [PubMed] [Google Scholar]
Associated Data
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Supplementary Materials
Data Availability Statement
All necessary data for replication of these finding is available in Supplemental Digital Content and in the PROSPERO record.