Axillary Vein Catheterization Periprocedural Care

Updated: Apr 08, 2016
  • Author: Ethan Levine, DO; Chief Editor: Vincent Lopez Rowe, MD  more...
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Periprocedural Care

Equipment

Equipment used for axillary vein catheterization includes the following:

  • Surgical blade, No. 10 or 15
  • Weitlaner retractors
  • Forceps
  • Bovie electrocautery pen
  • Army-Navy retractors
  • Needle, 18 gauge, and slip-tip syringe
  • Soft J-tip guide wire
  • Hemostatic sheath and dilator system
  • Fluoroscope
  • Ultrasound machine
  • Intravenous radiocontrast
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Patient Preparation

Anesthesia

Local anesthesia with 1% lidocaine is sufficient for accessing the axillary system with the aim of placing a central venous line. For more information, see Local Anesthetic Agents, Infiltrative Administration.

When the patient is particularly anxious, or when the vein is accessed for the purpose of placing a pacemaker or defibrillator, some degree of procedural sedation is customary and adds to patient comfort. Typically, sedation is achieved with titrated doses of intravenous benzodiazepines and narcotics; when the services of an anesthesiologist are available, propofol may be used. For more information, see Procedural Sedation.

General anesthesia is rarely required.

Positioning

Place the patient in the supine position. Prepare and drape the area in the customary sterile manner. Trendelenburg positioning is helpful because it leads to engorgement of the upper extremity venous system. When Trendelenburg positioning is used, an appropriate compensation with cranial angulation of the fluoroscopic camera should be used to maintain the standard view.

When a patient has difficulty lying flat and a wedge-shaped pillow or reverse Trendelenburg positioning is used, the image intensifier should be rotated to a degree of caudal angulation that is equivalent to the degree that the patient is elevated.

In addition, some practitioners use a folded towel or roll between the scapulae, which moves the lateral aspect of the clavicles posteriorly. This potentially facilitates access, especially in patients of greater habitus in whom the vein may be relatively deep.

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