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With the widespread adoption of ultrasound-guided (USG) techniques, the traditional landmark-guided infraclavicular approach for central venous cannulation has declined in use. The subclavian vein offers distinct advantages, and there are circumstances where central venous catheter insertion into the subclavian vein (SCV) is necessary, particularly when access to the internal jugular vein is difficult. When the conventional method is challenging, alternative strategies for SCV cannulation are required. This review examines current concepts and available evidence regarding USG supraclavicular brachiocephalic vein (SC-BCV) and infraclavicular axillary vein (IC-AXV) cannulation as practical alternatives for central venous access. USG SC-BCV cannulation has several advantages, including a shorter distance to the target vein, a more direct catheter trajectory to the superior vena cava, and reduced risks of pneumothorax and arterial puncture. Comparative studies and meta-analyses demonstrate higher first-attempt success rates and lower malposition rates compared with landmark-guided IC-SCV cannulation. USG IC-AXV cannulation is also increasingly recognized as a safe and effective option, particularly useful in patients with tracheostomy, chest wall injuries, or infection risks near conventional sites. Evidence suggests that success rates are comparable to those of internal jugular vein (IJV) cannulation, with fewer infectious complications in selected patients. Accumulating evidence supports USG SC-BCV and IC-AXV cannulation as reliable alternatives to both landmark-guided IC-SCV and USG IJV approaches.
During the era when central venous cannulation (CVC) was performed using blind, landmark-guided methods, the subclavian vein (SCV) was often preferred over the internal jugular vein (IJV). This preference was due to greater patient comfort, easier nursing care, and suitability for insertion in most clinical situations, including emergencies requiring airway management. In addition, because the SCV is reinforced by fibrous connective tissue, it is less prone to collapse, which is advantageous in hypovolemic states [1–4]. For these reasons, the SCV was historically considered the primary site for CVC, with the infraclavicular approach being the most widely employed technique.
However, early studies on ultrasound-guided (USG) CVC reported that SCV access was challenging because overlying bony structures hindered visualization, limiting the usefulness of ultrasound. Consequently, CVC via the IJV, where USG access is relatively straightforward, became the preferred approach, resulting in decreased interest in USG-guided SCV access [5–7]. Nevertheless, if SCV access can be optimized by modifying the ultrasound technique and approach, it may preserve the advantages of SCV cannulation and provide a viable alternative to either the landmark-guided infraclavicular SCV approach or the USG IJV approach.
This review focuses on two alternative approaches: USG supraclavicular brachiocephalic vein (SC-BCV) cannulation and infraclavicular axillary vein (IC-AXV) cannulation.
ANATOMY OF THE SCV
The SCV is the continuation of the AXV. It extends from the outer border of the first rib to the medial border of the anterior scalene muscle, where it joins the IJV to form the BCV, also known as the innominate vein (Fig. 1). The SCV follows the course of the subclavian artery (SCA) but is separated from it by the insertion of the anterior scalene muscle. As a result, the SCV lies anterior to the anterior scalene muscle, whereas the SCA is located posterior to it (anterior to the middle scalene muscle) [8]. For CVC, the right SCV is preferred over the left because it forms a more direct angle with the IJV, allowing a shorter guidewire passage to the superior vena cava. Selecting the right side also avoids proximity to the thoracic duct, which drains into the left SCV [1,5].
ULTRASOUND FOR VASCULAR ACCESS
The introduction of real-time ultrasound guidance for vascular puncture has significantly increased both the success rate and safety of CVC [5,6,9]. Vascular ultrasound employs high-frequency sound waves (5–15 MHz) with a linear array probe to generate images. By aligning the ultrasound beam along the long axis of the vessel, a sagittal image (long-axis view) can be obtained, while cross-sectional imaging produces a short-axis view. Neither view is definitively superior, as each offers distinct benefits and limitations. The long-axis view enables visualization of the needle, guidewire, and catheter throughout the puncture but does not permit clear imaging of adjacent arteries and requires a relatively straight vein. The short-axis view makes it easier to locate the target vein and its accompanying artery, thereby reducing the risk of arterial puncture, but needle visualization is more difficult [10,11]. With increasing experience in USG cannulation, the dynamic needle tip positioning method (also known as the creep technique) has been developed and widely adopted to improve needle tracking in the short-axis view [12,13]. Fig. 2 illustrates the creep technique. Regardless of the chosen view, differentiation between vein and artery must be confirmed in the short-axis plane [6,14]. The simplest method relies on compressibility, as veins collapse readily under probe pressure, unlike arteries. In addition, color Doppler is a valuable adjunct for distinguishing veins from arteries [2,5,15].
USG SC-BCV CANNULATION
Advantages and disadvantages
SC-BCV cannulation involves puncturing the proximal portion of the SCV, just before it merges with the IJV, so that the needle tip enters the BCV. While this was once performed using a landmark-guided method, the adoption of ultrasound has made the procedure easier and safer [16]. Compared with infraclavicular SCV (IC-SCV) cannulation, this approach provides several advantages: a well-defined insertion point at the clavisternomastoid angle (a useful reference when performing USG access), a shorter skin-to-vein distance, a more direct path to the superior vena cava, greater distance from the lung, and a lower risk of complications such as pleural or arterial puncture. Furthermore, it facilitates manual compression in cases of arterial puncture or after catheter removal and provides a larger target site, as the BCV is formed by the confluence of the IJV and SCV [17,18].
However, in the short-axis view, it can be difficult to clearly identify supraclavicular structures, so the procedure should generally be performed using the long-axis view. This requirement may pose challenges for practitioners who are less familiar with long-axis imaging.
Techniques
To perform SC-BCV cannulation, a linear transducer is positioned on the lateral neck just above the clavicle to identify the IJV and carotid artery. The IJV is then traced caudally into the supraclavicular fossa until the probe rests on the clavicle. While visualizing the most caudal aspect of the IJV, the probe is angled anteriorly to reveal the confluence of the IJV and SCV. At this point, the SCV lies anterior to the SCA. The operator should fan the probe dynamically from posterior to anterior to visualize both vessels. When anatomy is favorable, the relatively large and shallow SCV and BCV are easily visualized, simplifying access. However, anatomical variations mean that visualization may be difficult in some patients. Once clear sonographic visualization of the BCV is obtained, a small skin wheal is placed just lateral to the transducer [19]. Unlike conventional USG IJV cannulation, SC-BCV cannulation is usually performed in the long-axis view (Fig. 3). Because the skin-to-vein distance is typically less than 2 cm, cannulation can be achieved with relative ease [1,18,20]. The skin is punctured just lateral to the probe at an angle that will intersect the BCV at the desired point, depending on patient habitus and probe size. The needle is advanced slowly under US guidance, with continuous confirmation of the needle tip as it traverses soft tissue and enters the BCV. Venous entry is confirmed in the same way as at other CVC sites: aspiration of nonpulsatile dark blood, US visualization of the guidewire, and similar checks. Finally, a postprocedure chest radiograph is used to verify catheter tip placement and to identify pneumothorax, if present [7,18].
Comparison of USG SC-BCV and landmark-guided or USG IC-SCV cannulation
Complications during CVC include insertion failure and adverse events. In 2023, Imai et al. [21] published a meta-analysis comparing USG SC-BCV and IC-SCV cannulation. Their analysis of 2,482 cases from 17 studies showed that the SC approach had a significantly lower failure rate than the IC-SCV approach (relative risk [RR], 0.63; 95% confidence interval [CI], 0.47 to 0.86; I2=5%). The incidence of malposition (RR, 0.23; 95% CI, 0.13 to 0.39; I2=0%), arterial puncture, and pneumothorax was also slightly lower with the SC-BCV approach. Furthermore, the SC-BCV approach demonstrated a higher first-attempt success rate and shorter access time, although the study did not distinguish between USG and landmark-based blind techniques. In 2020, Prasad et al. [22] conducted a prospective randomized trial involving 110 patients, equally divided into USG SC and IC groups. The total procedure time was significantly shorter in the SC group compared with the IC group (P<0.0001). Visualization, puncture, and catheter insertion times were all significantly longer in the IC group (P<0.001). Both groups achieved a 100% overall success rate, but the SC group had a higher first-attempt success rate, although the difference was not statistically significant (P=0.171). In 2022, Saini et al. [23] reported a prospective randomized trial comparing USG SC cannulation with the IC approach, which in their study referred to AXV cannulation. The first-attempt success rate was 82.2% in the SC group and 62.2% in the IC group. Mean total access time was similar between groups: 99.11±34.66 seconds for SC and 103.44±50.27 seconds for IC. The number of puncture attempts was significantly higher in the IC group (1.40±0.54 vs. 1.20±0.46, P=0.04). Complication rates were low in both groups, at less than 5%.
Comparison of USG SC-BCV and IJV cannulation
USG IJV cannulation remains the most widely used method. However, multiple studies have compared it with USG BCV cannulation. In 2022, Gowda and Desai [24] conducted a prospective, single-blind, randomized trial that found overall cannulation success rates of 98.5% in the IJV group and 100% in the BCV group (P=0.31). First-attempt success was achieved in 76.3% of IJV cases and 81.81% of BCV cases (P=0.42). Vein collapse occurred in 14.5% of IJV cases but only 0.9% of BCV cases. Needle visualization was significantly better in the BCV group compared with the IJV group (94.54% vs. 80.0%, P=0.02). The number of needle redirections was also higher in the IJV group. In another prospective randomized trial, Aydın et al. [25] compared USG SC-BCV cannulation using the needle-in-plane (long-axis) technique with USG IJV cannulation using the needle-out-of-plane (short-axis) technique. Mean cannulation time was similar between groups: 27.65±25.36 seconds for SC-BCV and 28.16±21.72 seconds for IJV. Overall success rates were nearly identical (97.6% for SC-BCV vs. 97.7% for IJV). The mean ease-of-procedure score was also comparable: 8.78±1.13 for SC-BCV and 8.67±1.23 for IJV. A 2024 systematic review and network meta-analysis compared USG SC-SCV (or BCV), IC-SCV, proximal AXV, and distal AXV cannulation [18]. The SC-SCV (BCV) approach was found to increase the likelihood of first-attempt success compared with the other approaches. RRs for SC-SCV (BCV) exceeded 1.21, with lower 95% CI values consistently above 1. When compared specifically to IJV cannulation, the SC-SCV (BCV) approach likely improved first-attempt success (RR, 1.22; 95% CI, 1.06 to 1.40 [moderate confidence]). In contrast, the distal AXV approach reduced the likelihood of first-attempt success (RR, 0.72; 95% CI, 0.59 to 0.87 [high confidence]). Arterial puncture rates showed little to no difference across approaches (low to high confidence).
USG IC-AXV CANNULATION
Advantages and disadvantages
USG IC-AXV cannulation offers several advantages over other CVC techniques. Anatomical features are favorable for ultrasound guidance, which contributes to fewer complications. If arterial injury occurs, manual compression of the axillary artery (AXA) or surgical access is possible. The puncture site is also located farther from potential sources of infection in patients with tracheostomy, central chest wall burns, or sternotomy wounds [6,26]. Once mastered, this approach is considered safe, reliable, and effective for central venous access [27]. Thus, the AXV is a viable alternative for CVC, and it has been shown to be an effective substitute for USG IJV and SCV cannulation. When planning venous puncture, posterior anatomical structures must be considered. The medial portion of the AXV, like the SCV, is bordered posteriorly by the ribs and lung. Moving laterally, the anterior chest wall slopes posteriorly, which increases the distance between the vein and the lung. At the most lateral aspect of the AXV, there are no clinically significant posterior structures that are at risk of injury during cannulation [28,29].
In contrast to the SCV, which is relatively deep and shielded by surrounding structures, the AXV is more superficial and influenced by nearby muscles and soft tissues. As a result, it is more prone to collapse, which can make cannulation technically challenging [30,31].
Techniques
In a transverse or oblique ultrasound view, the AXV is visualized from the shoulder joint to the point where it passes between the clavicle and first rib. After identifying the AXV, AXA, cephalic vein, and first rib, the probe is moved back toward the shoulder joint to visualize the distal AXV before it divides into the basilic and brachial veins. The segment of the AXV closest to the skin, just distal to the SCV, is selected as the puncture site, and the vein is reconfirmed in a long-axis view (Fig. 4). In some cases, if the distance between the clavicle and AXV is sufficient to allow probe placement, cannulation can be performed using a short-axis view (Fig. 5). The introducer needle is aligned with the ultrasound probe and advanced at approximately a 45° angle. Once the needle tip penetrates the vein wall, the angle is slightly adjusted to facilitate guidewire advancement. The guidewire is then introduced, followed by catheter insertion over the wire. Final confirmation of catheter position and exclusion of pneumothorax are achieved with chest radiography [27,32–34].
Comparison of USG IC-AXV and landmark-guided or USG IC-SCV cannulation
Previous studies have divided patients into proximal and distal AXV groups, noting that the puncture site for the proximal AXV is the same or closely corresponds to the landmark-guided SCV site. In a randomized controlled noninferiority trial published by Buzançais et al. [35] in 2016, 119 of 122 patients were analyzed (57 in the proximal group and 62 in the distal group). Primary success rates were 87.7% for proximal and 85.5% for distal cannulation (difference –2.2%; 90% CI, –12.5% to 8.1%; noninferiority P=0.18). Overall success rates were 96.5% and 98.4%, respectively (difference, –1.9%; 90% CI, –4.9% to 8.7%; noninferiority P<0.01). Thrombogenic catheter tip positioning occurred in 7 cases (12.3%) in the proximal group and 19 cases (31.7%) in the distal group (P=0.01). Complication rates were similar (3.3% vs. 6.5%, P=0.68). The authors concluded that, although the distal approach was not inferior to the proximal approach in terms of absolute and overall success, its association with more thrombogenic catheter positioning suggests it should primarily serve as a rescue option after proximal failure. In a randomized controlled trial by Su et al. [36] in 2020, involving 198 cardiac surgery patients (99 proximal and 99 distal), the proximal group achieved a significantly higher first-puncture success rate (75.8% vs. 51.5%, P<0.001) and site success rate (93.9% vs. 83.8%, P=0.04). Overall success rates were identical (99.0% vs. 99.0%, P=1.00). The proximal approach required fewer puncture attempts (P<0.01), shorter access time (P<0.001), and shorter cannulation time (P<0.001). Complication rates, including bleeding, arterial puncture, pneumothorax, nerve injury, and catheter misplacement, showed no significant differences between groups. The authors concluded that both proximal and distal USG AXV cannulation are feasible and safe options for cardiac surgery patients at risk of bleeding. However, the proximal approach offers clear advantages in terms of first-puncture success and procedural efficiency. They also emphasized the need for large-scale follow-up studies directly comparing USG IC-SCV (proximal AXV) and distal AXV cannulation.
Comparison of USG IC-AXV and USG IJV cannulation
In a retrospective study published by O’Leary et al. [37] in 2012, successful cannulation was achieved in 2,572 patients (99.5%). This included 1,644 cases in the right AXV group, 279 in the left AXV group, 547 in the right IJV group, 89 in the left IJV group, 13 using other techniques, and 14 failures (0.5%). Procedural complications occurred in 48 cases (1.9%). They concluded that the axillary route appeared to be a safe and effective alternative to the IJV. In a prospective randomized controlled open-label pilot trial published by Fournil et al. [38] in 2023, 173 of 210 patients were fully analyzed (90 in the IJV group and 83 in the AXV group). Overall success rates were 96% (95% CI, 90% to 99%) for the IJV and 89% (95% CI, 81% to 94%) for the AXV. First-puncture success rates were 90% and 80%, respectively. Median overall procedure time, measured from ultrasound pre-procedural screening to guidewire insertion, was 8 minutes for the IJV and 10 minutes for the AXV. Immediate complication rates were 11.6% for the IJV and 14.6% for the AXV. Catheter colonization occurred in 7.9% of IJV cases and 6.8% of AXV cases, while catheter-related infections were reported in 2.6% of IJV cases and none in AXV cases. The study concluded that US-guided low IJV and AXV approaches were both safe and efficient, with high success rates and low complication profiles. In a 2023 prospective randomized trial by Czarnik et al. [39], the IJV puncture success rate was 100% and the AXV puncture success rate was 99.7% (P=0.19, chi-square test) in mechanically ventilated patients. Cannulation success was achieved in 98.7% of IJV cases and 96.7% of AXV cases (P=0.11, chi-square test). Catheter tip malposition occurred in 9.9% of IJV cases and 10.1% of AXV cases (P=0.67, chi-square test). Early mechanical complication rates were 3% in the IJV group (common carotid artery puncture in four cases, perivascular hematoma in two, vertebral artery puncture in one, and pneumothorax in one) and 2.6% in the AXV group (AXA puncture in four cases and perivascular hematoma in four cases; P=0.7, chi-square test). No significant difference was found between real-time USG out-of-plane (short-axis) IJV cannulation and infraclavicular real-time USG in-plane (long-axis) AXV cannulation. Both techniques were determined to be equally effective and safe in critically ill, mechanically ventilated patients.
CONCLUSION
This review demonstrates USG SC-BCV and IC-AXV cannulation are reliable alternatives to traditional landmark-guided IC-SCV and USG IJV techniques. Both approaches are associated with high overall success rates, improved needle visualization, and favorable safety profiles, with lower risks of complications such as arterial puncture and pneumothorax. Evidence from randomized controlled trials and meta-analyses supports their clinical applicability, particularly in patients with challenging anatomy or contraindications to IJV cannulation.
ARTICLE INFORMATION
Conflicts of interest
The author has no conflicts of interest to declare.
Funding
The author received no financial support for this study.
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.
Fig. 1.
Anatomy of the brachiocephalic, subclavian, and axillary veins (right side).
Fig. 2.
Creep method (dynamic needle tip positioning). (1) The skin and vein are punctured, ensuring that the needle tip is visible at the center of the intravenous lumen. (2) The probe is advanced slightly forward until the needle tip disappears within the lumen. (3) The needle is gently advanced further while maintaining control of its positioning. Steps 1 to 3 are repeated at least twice to confirm that the entire outer cannula of the catheter is successfully inserted into the vein.
Fig. 3.
Ultrasound-guided brachiocephalic vein (BCV) cannulation. (A) Placement of the ultrasound probe and entry direction of the probe needle. (B) Ultrasound image of the BCV (long-axis view). IJV, internal jugular vein; SCV, subclavian vein.
Fig. 4.
Ultrasound-guided axillary vein (AXV) cannulation (long-axis view). (A) Placement of the ultrasound probe and direction of the probe needle. (B) Ultrasound image of the AXV.
Fig. 5.
Ultrasound-guided axillary vein (AXV) cannulation (short-axis view). (A) Placement of the ultrasound probe and direction of the probe needle. (B) Ultrasound image of the axillary vein (short-axis view). AXA, axillary artery.
REFERENCES
1. Marino PL. The ICU book. 3rd ed. Lippincott Williams & Wilkins; 2007.
4. Gaus P, Heß B, Müller-Breitenlohner H. Ultrasound-guided infraclavicular venipuncture at the junction of the axillary and subclavian veins. Anaesthesist 2015;64:145–51.
7. Imai E, Kataoka Y, Watanabe J, et al. Ultrasound-guided central venous catheterization around the neck: systematic review and network meta-analysis. Am J Emerg Med 2024;78:206–14.
11. Flynn BC, Mensch J. Best practice in ultrasound-guided internal jugular vein cannulation: the debate echoes on. J Cardiothorac Vasc Anesth 2019;33:2985–8.
12. Canadian Internal Medicine Ultrasound. Canadian Internal Medicine Ultrasound (CIMUS) consensus statement: recommendations for mandatory ultrasound competencies for ultrasound-guided thoracentesis, paracentesis, and central venous catheterization. Ultrasound J 2024;16:21.
13. Shim JG, Cho EA, Gahng TR, et al. Application of the dynamic needle tip positioning method for ultrasound-guided arterial catheterization in elderly patients: a randomized controlled trial. PLoS One 2022;17:e0273563.
14. Gawda R, Czarnik T, Łysenko L. Infraclavicular access to the axillary vein: new possibilities for the catheterization of the central veins in the intensive care unit. Anaesthesiol Intensive Ther 2016;48:360–6.
15. Saugel B, Scheeren TW, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care 2017;21:225.
16. Kim YJ, Ma S, Yoon HK, Lee HC, Park HP, Oh H. Supraclavicular versus infraclavicular approach for ultrasound-guided right subclavian venous catheterisation: a randomised controlled non-inferiority trial. Anaesthesia 2022;77:59–65.
18. Patrick SP, Tijunelis MA, Johnson S, Herbert ME. Supraclavicular subclavian vein catheterization: the forgotten central line. West J Emerg Med 2009;10:110–4.
19. Tomar GS, Chawla S, Ganguly S, Cherian G, Tiwari A. Supraclavicular approach of central venous catheter insertion in critical patients in emergency settings: re-visited. Indian J Crit Care Med 2013;17:10–5.
20. Breschan C, Graf G, Jost R, et al. A retrospective analysis of the clinical effectiveness of supraclavicular, ultrasound-guided brachiocephalic vein cannulations in preterm infants. Anesthesiology 2018;128:38–43.
21. Imai E, Watanabe J, Okano H, Yokozuka M. Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterisation: an updated systematic review and meta-analysis of randomised controlled trials. Indian J Anaesth 2023;67:486–96.
22. Prasad R, Soni S, Janweja S, Rajpurohit JS, Nivas R, Kumar J. Supraclavicular or infraclavicular subclavian vein: which way to go: a prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance. Indian J Anaesth 2020;64:292–8.
25. Aydın T, Balaban O, Turgut M, Tokur ME, Musmul A. A novel method for ultrasound-guided central catheter placement-supraclavicular brachiocephalic vein catheterization versus jugular catheterization: a prospective randomized study. J Cardiothorac Vasc Anesth 2022;36:998–1006.
28. Sidoti A, Brogi E, Biancofiore G, et al. Ultrasound- versus landmark-guided subclavian vein catheterization: a prospective observational study from a tertiary referral hospital. Sci Rep 2019;9:12248.
29. Lavallée C, Ayoub C, Mansour A, et al. Subclavian and axillary vessel anatomy: a prospective observational ultrasound study. Can J Anaesth 2018;65:350–9.
30. Roger C, Sadek M, Bastide S, et al. Comparison of the visualisation of the subclavian and axillary veins: an ultrasound study in healthy volunteers. Anaesth Crit Care Pain Med 2017;36:65–8.
33. He YZ, Zhong M, Wu W, Song JQ, Zhu DM. A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation by experienced operators. J Thorac Dis 2017;9:1133–9.
34. Subramony R, Spann R, Medak A, Campbell C. Ultrasound-guided vs. landmark method for subclavian vein catheterization in an academic emergency department. J Emerg Med 2022;62:760–8.
36. Su Y, Hou JY, Ma GG, et al. Comparison of the proximal and distal approaches for axillary vein catheterization under ultrasound guidance (PANDA) in cardiac surgery patients susceptible to bleeding: a randomized controlled trial. Ann Intensive Care 2020;10:90.
37. O'Leary R, Ahmed SM, McLure H, et al. Ultrasound-guided infraclavicular axillary vein cannulation: a useful alternative to the internal jugular vein. Br J Anaesth 2012;109:762–8.
38. Fournil C, Boulet N, Bastide S, et al. High success rates of ultrasound-guided distal internal jugular vein and axillary vein approaches for central venous catheterization: a randomized controlled open-label pilot trial. J Clin Ultrasound 2023;51:158–66.
39. Czarnik T, Czuczwar M, Borys M, et al. Ultrasound-guided infraclavicular axillary vein versus internal jugular vein cannulation in critically ill mechanically ventilated patients: a randomized trial. Crit Care Med 2023;51:e37–44.
Ultrasound-guided brachiocephalic and axillary venous cannulation: a narrative review
Fig. 1. Anatomy of the brachiocephalic, subclavian, and axillary veins (right side).
Fig. 2. Creep method (dynamic needle tip positioning). (1) The skin and vein are punctured, ensuring that the needle tip is visible at the center of the intravenous lumen. (2) The probe is advanced slightly forward until the needle tip disappears within the lumen. (3) The needle is gently advanced further while maintaining control of its positioning. Steps 1 to 3 are repeated at least twice to confirm that the entire outer cannula of the catheter is successfully inserted into the vein.
Fig. 3. Ultrasound-guided brachiocephalic vein (BCV) cannulation. (A) Placement of the ultrasound probe and entry direction of the probe needle. (B) Ultrasound image of the BCV (long-axis view). IJV, internal jugular vein; SCV, subclavian vein.
Fig. 4. Ultrasound-guided axillary vein (AXV) cannulation (long-axis view). (A) Placement of the ultrasound probe and direction of the probe needle. (B) Ultrasound image of the AXV.
Fig. 5. Ultrasound-guided axillary vein (AXV) cannulation (short-axis view). (A) Placement of the ultrasound probe and direction of the probe needle. (B) Ultrasound image of the axillary vein (short-axis view). AXA, axillary artery.
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Fig. 4.
Fig. 5.
Ultrasound-guided brachiocephalic and axillary venous cannulation: a narrative review
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