• Natalie Htet, Jessica Vaughn, Sasikanth Adigopula, Erin Hennessey, and Frederick Mihm.
• Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, United States.
• J Crit Care. 2017 Oct 1; 41: 194-197.

PurposeAxillary arterial cannulation for blood pressure monitoring has been reported in adults since 1973. Reported failure rates using palpation landmarks are high. This report describes a needle-guided ultrasound technique for axillary arterial line placement in critically ill patients.MethodsA retrospective review of all patients requiring axillary arterial cannulation attempts with ultrasound-assisted needle guidance for hemodynamic monitoring was performed from July 2010 to June 2016 at a single institution.ResultsOne hundred fifty nine (159) cannulation attempts were performed in 155 patients. The overall success rate was 97%, with a first pass success rate of 84%. Inexperienced operators performed 49% of procedures under direct faculty supervision, and had a 99% success rate, which was not different from experienced operators. Almost 20% of patients had moderate-to-severe coagulopathy (platelets<50k/uL, INR>2.0 or PTT>60s). Complications reported included the following: nonfunctioning of catheter (6%) and hematoma (6%). Ischemia was noted in 2 patients (1%), but only one was attributed to the arterial catheter.ConclusionsUse of the needle-guided ultrasound assisted approach for axillary arterial line placement is easily teachable and can be used to promote safe and successful placement of axillary arterial lines for novice learners.Copyright © 2017 Elsevier Inc. All rights reserved.

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