Cathétérisme de l'artère pulmonaire par abord percutané de la veine axillaire

Abstract

The choice of venous access can be difficult in patients under intensive care. The axillary vein appeared interesting to evaluate. This prospective study involved 63 punctures carried out in 59 patients during a 16 month period (14 females and 45 males; mean age : 54±4 yr). 34 patients were tracheostomized and under controlled respiration; some had coagulation abnormalities (8 cases). The other 29 patients were undergoing a preoperative haemodynamic study. Puncture of the axillary vein was carried out with the needle inserted at an angle of 30° to the skin surface and directed parallel to the artery medial to its course. The Seldinger technique was used (catheter and guide wire). Overall success rate was 87.5 %. In 73 %, less than three attempts were required. After the catheter was set in place in the axillary vein, the mean time required to reach the pulmonary artery was 7±15 min (range : 20 s-45 min). Less than 1 min was needed in 60 %. Extrasystoles were observed in 3.6 %. The incidence of arterial puncture was 11 % without any late complications. In every case, pulmonary artery and capillary wedge pressure curves were obtained, as well as cardiac output measurements. Mean duration of catheterization was 2±1.1 days in the preoperative haemodynamic group and 4±1.7 days in the other. No infectious complication was related to the catheterization. One thrombosis of the axillary and suclavian veins was noted (1.8 %). The axillary vein appeared therefore to be useful for pulmonary artery catheterization. It is an alternative choice in patients under controlled ventilation and with coagulation problems.