ABSTRACT
BACKGROUND: Despite its potential advantages, ultrasound-guided cannulation of the axillary vein in the infraclavicular area is still rarely used as an alternative to other techniques. There are few large series demonstrating the safety and feasibility of this approach. METHODS: Retrospective analysis of data on patients undergoing ultrasound-guided, long-axis, in-plane infraclavicular axillary vein cannulation for the incidence of complications and the failure rate from two secondary-care hospitals. RESULTS: The analysis included 710 successful attempts of axillary vein long-axis, in-plane, US-guided cannulation, and 24 (3.3%) failed attempts. We recorded a 96.7% success rate with an overall incidence of complications of 13%, mainly malposition (8.1%). There was one case of pneumothorax (0.14%), five cases of arterial puncture (0.7%), and two cases of brachial plexus injury. CONCLUSIONS: The US-guided axillary central venous cannulation (CVC) access technique can be undertaken successfully in patients, even in challenging circumstances. Taken together with existing work on the utility and safety of this technique, we suggest that it should be adopted more widely in clinical practice.
Subject(s)
Catheterization, Central Venous , Ultrasonography, Interventional , Humans , Retrospective Studies , Ultrasonography, Interventional/methods , Axillary Vein/diagnostic imaging , Ultrasonography , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methodsABSTRACT
BACKGROUND: Most injuries observed in victims of lightning strikes can be explained by electrothermal phenomena. Blast penetrating injuries caused by a lightning-strike-induced explosion of a nearby structure are rarely reported. CASE PRESENTATION: Here reported is the case of a patient with numerous mixed injuries caused by a lightning strike, including deep lacerations of both hips and thighs with rock fragments embedded in the wounds. Surgical removal of rock fragments from deep areas of the right hip and right lower leg was necessary. The cause of the formation of rock missiles was the lightning-strike-induced explosion of rock. Rapid evaporation of water enclosed in rock crevices was presumably the main force underlying the explosion. CONCLUSION: Blast penetrating injuries should be considered and excluded in all patients struck by lightning, particularly when occurring in rocky terrain. The diagnosis and treatment of such injuries can be difficult and require special preparation.
