Ultrasound-guided axillary artery cannulation in the infraclavicular area: A step-by-step approach

Percutaneous arterial cannulation for arterial catheter placement is a commonly performed procedure in intensive care. In many cases routinely cannulated radial arteries may be inaccessible because of shock, arteriosclerosis, or vasoconstriction. In this scenario, femoral or axillary artery may be chosen for arterial catheter placement. Percutaneous cannulation of the axillary artery via the infraclavicular route has two main advantages over cannulation of the femoral artery: avoidance of cannulation of the artery affected by arteriosclerosis and microbiological safety by avoiding cannulation in the inguinal area. This paper describes ultrasound-guided, real-time infraclavicular cannulation of the axillary artery for arterial catheter placement in critically ill patients. The cannulation technique is described in a step-by-step manner. In addition, the limitations of this arterial approach are presented together with the indications and contraindications. The pitfalls that are likely to occur during cannulation via the infraclavicular route are also reviewed.