Real‐time ultrasound‐guided axillary vein cannulation in children: a randomised controlled trial

Summary The axillary vein is a good site for ultrasound‐guided central venous cannulation in terms of infection rate, patient comfort and its anatomical relationship with the clavicle and lungs. We compared real‐time ultrasound‐guided axillary vein cannulation with conventional infraclavicular landmark‐guided subclavian vein cannulation in children. A total of 132 paediatric patients were randomly allocated to either ultrasound‐guided axillary vein (axillary group) or landmark‐guided subclavian vein (landmark group). The outcomes measured were success rate after two attempts, first‐attempt success rate, time to cannulation and complication rate. The success rate after two attempts was 83% in the axillary group compared with 63% in the landmark group (odds ratio 2.85, 95%CI 1.25–6.48, p = 0.010). The first‐attempt success rate was 46% for the axillary group and 40% for the landmark group (p = 0.274) and median time to cannulation was 156 s for the axillary group and 180 s for the landmark group (p = 0.286). There were no differences in complication rates between the two groups, although three episodes of subclavian artery puncture occurred in the landmark group (p = 0.08). We conclude that axillary vein cannulation using a real‐time ultrasound‐guided in‐plane technique is useful and effective in paediatric patients.