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Abstract

Introduction: Real-time ultrasound guidance is considered to be the standard of care for central venous access for non-emergent central lines. Traditional sites for ultrasound guided central line placement are the internal jugular vein and subclavian vein via an infraclavicular approach. The AxoTrack system (Soma Access Systems, Greenville, SC) recently cleared for human use by the United States Food and Drug Administration, is a novel ultrasound guidance system designed to simplify ultrasound guided central venous access by eliminating the hand-eye coordination challenges of conventional ultrasound needle guidance. The ultrasound probe houses a separate set of magnetic sensors that, in real-time, precisely monitors the depth of the needle and projects on the ultrasound system monitor a virtual image of the needle as it moves through the tissue toward and into the target vein. The design and function of the device facilitates a unique approach to ultrasound guided supraclavicular approach to cannulation of the subclavian vein. Methods: After FDA clearance, the AxoTrack system was released to three hospitals in the United States. Physicians and Nurse Practitioners who work in the Intensive Care Unit or Emergency Department and who place central venous catheters were trained to use the AxoTrack system. De-identified quality assurance data was prospectively collected at each of the three hospitals every time the AxoTrack system was used for central venous cannulation (CVC) to determine if the system was successful and to describe any complications from the procedure. After IRB review, we consolidated the data for the first 100 central line procedures for retrospective review. Results: The AxoTrack system was used in 100 consecutive patients undergoing central venous cannulation from September 2012 to July 2013. A subset of 33 patients underwent supraclavicular access with no reported complications, including pneumothorax, hemothorax, arterial puncture, or arterial cannulation. Conclusions: The AxoTrack system is a safe, straightforward, and effective tool that facilitates CVC insertion at an alternative site. Furthermore, this device can be used by a variety of health care practitioners with little additional training.