• Tomasz Czarnik, Miroslaw Czuczwar, Michal Borys, Olimpia Chrzan, Kamil Filipiak, Magdalena Maj, Maciej Marszalski, Marta Miodonska, Maciej Molsa, Marek Pietka, Maciej Piwoda, Pawel Piwowarczyk, Zuzanna Rogalska, Jakub Stachowicz, and Ryszard Gawda.
• Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland.
• Crit. Care Med. 2023 Feb 1; 51 (2): e37e44e37-e44.

ObjectivesThis clinical trial aimed to compare the ultrasound-guided in-plane infraclavicular cannulation of the axillary vein (AXV) and the ultrasound-guided out-of-plane cannulation of the internal jugular vein (IJV).DesignA prospective, single-blinded, open label, parallel-group, randomized trial.SettingTwo university-affiliated ICUs in Poland (Opole and Lublin).PatientsMechanically ventilated intensive care patients with clinical indications for central venous line placement.InterventionsPatients were randomly assigned into two groups: the IJV group ( n = 304) and AXV group ( n = 306). The primary outcome was to compare the IJV group and AXV group through the venipuncture and catheterization success rates. Secondary outcomes were catheter tip malposition and early mechanical complication rates. All catheterizations were performed by advanced residents and consultants in anesthesiology and intensive care.Measurements And Main ResultsThe IJV puncture rate was 100%, and the AXV was 99.7% (chi-square, p = 0.19). The catheterization success rate in the IJV group was 98.7% and 96.7% in the AXV group (chi-square, p = 0.11). The catheter tip malposition rate was 9.9% in the IJV group and 10.1% in the AXV group (chi-square, p = 0.67). The early mechanical complication rate in the IJV group was 3% (common carotid artery puncture-4 cases, perivascular hematoma-2 cases, vertebral artery puncture-1 case, pneumothorax-1 case) and 2.6% in the AXV group (axillary artery puncture-4 cases, perivascular hematoma-4 cases) (chi-square, p = 0.79).ConclusionsNo difference was found between the real-time ultrasound-guided out-of-plane cannulation of the IJV and the infraclavicular real-time ultrasound-guided in-plane cannulation of the AXV. Both techniques are equally efficient and safe in mechanically ventilated critically ill patients.Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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