ULTRASOUND GUIDED OUT-OF-PLANE VERSUS IN-PLANE TRANSPECTORAL APPROACH FOR RIGHT AXILLARY VEIN CANNULATION – PROSPECTIVE RANDOMISED INTERVENTIONAL STUDY

Centralvenous cannulation is performed routinely in critically ill patients and those undergoing major surgical procedures for hemodynamic monitoring, infusion of vaso-active substances and for rapid fluid resuscitation or rapid blood replacement therapy.Ultrasound(US) guidance is now considered the gold standard technique for central venous catheter insertion viainternal jugular vein (IJV). The subclavian vein(SCV) is a useful alternative to the IJV and the landmark technique have been in practice for many years, despitethe potential procedural complications. Itis not easily amenable to US-guided access, because the clavicle obstructs the view of the vessels . Incontrast the axillary vein that extends from the lateral border of the first rib to the outer border of the teres majoris visible with ultrasound and is becomingthe popular route for centralvenous access. The axillary vein is an easily accessible vessel thatcan be used for ultrasound- guided central vascular access and offers analternative site to the internal jugularand subclavian vein and ultrasound guidance has been shown to improve the chances of successful axillaryvein cannulation while minimizing the complications.