The Evaluation Of Transpectoral Ultrasound-Guided Catheterization Of Axillary Vein And Determination The Best Insertion Point

Objective:To observe the anatomy of the axillary vein,identify the relationships of axillary vein and the surrounding tissue;To evaluate ultrasound-guided axillary vein catheterization results and to develop the best puncture point.Methods:The first phase means locating and measuring the axillary vein with ultrasound.Totally 121 samples are collected,making sure the age is 20-75 years,height 150-180cm and BMI 18.5-24.9kg/m2.Do ultrasonic measurement of the axillary vein as well as the accompanying axillary artery's depth,diameter,distance from the clavicle,the distance from the pleura and the diatance between the two blood vessels in the chest area.21 cases are included in the left measurement group.12 cases undergo contrast measurement of the right upper extremity abduction 0°and 90°.The second phase of ultrasound-guided axillary vein puncture includes 21 patients taking elective operation and requiring deep venous catheter for general anesthesia,whose ASA isⅠ-Ⅱgrade and height,age and BMI follow the standard above-metioned.According to the result under the first phase,we use real-time ultrasound guidance and in-plane technique to practice axillary vein catheterization during which we record needle angle,depth of needle insertion,puncture frequency,the distance between the puncture point and the clavicle and whether any complication occurs.In the postoperative period,we follow up the patients and record catheter retention time,dressing care and their feeling.Finally,we summary transpectoral axillary vein puncture site and evaluate the results.Results:The second section of the axillary vein is suitable for central venous catheterization as the entry way.According to the coverage of pectoralis minor muscle observed by ultrasound,the region, which is lcm-3cm lateral of the midpoint of the lower edge of the clavicle belongs to the second section of the axillary vein.From the inside to outside,the distance between the axillary vein and the clavicle increases,so as the distance between the axillary artery and vein, and the rate of pleural visibility discreases.Between different genders,the depth of the axillary artery and vein shows a significant statistical difference,but there exits no clinical significance.Female samples,between different BMI block,the depth of the axillary artery and vein also shows statistically significant effect,but no clinical significance of the difference between the same.Male samples,different BMI block has no significant effect on the depth of the axillary artery and vein.With upper extremity abduction 90°position,in the proposed area, the depth of the vein shallows,but instead the diatance between the artery and vein becomes narrower,which increases the risk of puncture.Comparison of right and left sides,from the midpoint of the lower edge of the clavicle to 1cm lateral,the left axillary vein is steeper;In the 2cm outside the midpoint and the lateral area,the distances from the artery and vein to the clavicle on both sides are basically the same.Then we use in-palne technique and real-time ultrasound guidance to do the axillary vein puncture.On the vertical line 3cm outside the midpoint of the lower edge of the clacivle,the distance from the puncture point to the clavicle is 5.22±0.43cm.Then we puncture toward the point 1cm inside the midpoint of the clavicle,the average needle angle is 42±4°,the average depth of needle insertion is 4.6±0.6cm and the average number of puncture times is 1.6.No hematoma,pneumothorax, nerve injury or other complications.According to the postoperative follow-up result,the average catheter retaining time is 11 days and no infection or discomfort except one case of a litter redness at the puncture point.Conclusion:Select the second section of the axillary vein in the chest area as central venous catheterization access road is feasible,the patients have no complaints.Select the vertical line 3cm outside the midpoint of the clavicle and 5.3cm away from the lower edge of the clavicle as the puncture point.Using the real-time ultrasound guidance can complete the catheterization successfully.This visualization technology reduces risk,improves the success rate and prevents concurrent diseases.But how to make it in the blind under the same security needs further study.