The journal of vascular access
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Observational Study
Dynamic variation of the axillary veins due to intrathoracic pressure changes: A prospective sonographic study.
The ultrasound-guided axillary vein is becoming a compulsory alternative vessel for central venous catheterization and the anatomical position offers several potential advantages over blind, subclavian vein techniques. ⋯ Anatomical variations in depth and diameter as well as the collapsibility due to intrathoracic pressures changes represent common challenges that face clinicians during central venous catheterization of the axillary vein. A noteworthy increase in vessel size as patients transition from spontaneous to mechanical ventilation may theoretically improve first-pass cannulation success with practitioners skilled in both ultrasound and procedure. As a result, placing a centrally inserted central catheter after the induction of anesthesia may be beneficial.
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Observational Study
Arm position and collapsibility of infraclavicular axillary vein during voluntary breathing: An ultrasound-guided observational study.
Arm abduction influences cross-sectional area of the infraclavicular axillary vein, yet the effect of arm abduction on collapsibility of the vein has not been quantified. Decrease in collapsibility of the axillary vein can enable successful cannulation and can decrease injury to underlying vital structures. ⋯ We conclude that the collapsibility of the infraclavicular axillary vein could be reduced by arm abduction, and hence, abduction could be proposed as the ideal arm position for ultrasound-guided infraclavicular axillary vein cannulation.
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Case Reports
Ipsilateral vocal fold paralysis: An unusual complication of internal jugular tunnelled dialysis catheter insertion.
Central venous catheters are extensively used in critical care units and in dialysis centres to gain access to the blood stream for the purpose of invasive monitoring, drug administration, parenteral nutrition and to perform renal replacement therapy. One of the common areas of central venous catheter insertion is right internal jugular vein due to its anatomical continuity with the superior vena cava. The complication rates of central venous catheter insertion can be more than 15%, including early and late complications. ⋯ This case illustrates an unusual complication of central venous catheter insertion and the importance of recognizing the possibility of such complications, to prevent them from happening and also to manage them appropriately.