Utility of Ultrasound Versus Landmark-Guided Axillary Artery Cannulation for Hemodynamic Monitoring in the Intensive Care Unit

Objectives. To assess the utility of ultrasound-guided axillary artery catheterization compared with anatomical landmark technique catheterization in the intensive care unit. Design. Randomized controlled trial. Setting. University hospital surgical and neurosurgical intensive care unit. Patients. A total of 33 critically ill patients undergoing arterial line placement. Interventions. Axillary arterial line placement under ultrasound guidance or by using anatomical landmarks. Measurements and main results. Procedure duration, number of attempts (skin punctures), needle repositionings, and aborted procedures were compared. A total of 33 patients were randomly assigned to either the ultrasound group (n = 18) or the anatomical landmark group (n = 15). Aborted procedures were significantly greater in the landmark group (n = 4) than in the ultrasound group (n = 0); P = .019. Procedure duration (mean ± SD) in the ultrasound group was 7.01 ± 4.40 minutes compared with 9.29 ± 10.00 minutes in the landmark group; P = .360. A significant reduction in overall procedure duration for fellow operators (5.83 ± 3.64 minutes) versus resident operators (11.46 ± 9.41 minutes) was noted; P = .012. The number of attempts in the landmark group was 3.07 ± 2.96 compared with 2.44 ± 1.72 in the ultrasound group; P = .46. The number of needle repositionings was 4.06 ± 2.86 times per procedure in the ultrasound group, compared with 10.00 ± 13.45 in the landmark group; P = .077. Conclusion. Ultrasound-guided axillary arterial catheter placement increases the success rate of line placement with no significant decrease in the duration of the procedure and the number of needle punctures or repositionings.