The use of ultrasound for axillary artery catheterization through pectoral muscles: a new anterior approach.

A palpable axillary artery pulse is a prerequisite for introducing an arterial line. The close proximity of four nerves to the artery increases the chance of nerve injury, especially in anesthetized patients. The highly colonized entry site results in frequent infection. Approaching the axillary artery through the pectoral muscles by using real-time imaging should improve success, decrease infection, and prevent nerve and vessel injuries because these structures and the needle can be visualized directly. I describe three patients who had successful axillary lines placed through the pectoral muscles by using real-time sonography. The ability to see the artery, surrounding nerves, and vein and to observe the needle going through the tissues should increase safety and success, although a large study is needed to prove these hypotheses.