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Long-Axis Versus Short-Axis View of Ultrasound-Guided Central Venous Cannulation.

Critical Care Medicine www.ccmjournal.org e597 The authors reply: We thank Maheshwari and Maheshwari (1) for their comments and interest in our study (2) to evaluate long-axis and short-axis views to cannulate the internal jugular and subclavian veins. The authors suggest caution while using the long-axis view for central venous cannulation as one must maintain the continuous visualization in the long-axis plane so as not to lose sight of the needle tip. We agree that maintaining continuous visualization is necessary and believe that emergency physician ultrasound operators can successfully maintain continual visualization of the needle during central venous catheterization, especially if long-axis view is taught during ultrasound instruction during residency training and at conferences. In our study, we found decreased redirections using the long-axis approach at both the subclavian and internal jugular sites, which may be due to the advantages afforded by continuous visualization of the needle tip in the long axis, thereby necessitating fewer redirections (2). We recognize that institutions will have practice variations for performing ultrasound-guided vascular access, and we appreciate the authors suggesting the “marking” technique. We are not familiar with this approach, but given that many veins are very collapsible, we do not see the value in measuring the depth of the internal jugular vein. In fact, we wonder if this practice would give the individual performing the procedure a false sense of security in placing a needle deeper than needed if the vessel was compressed. We maintain that entirety of the needle is visualized during central venous cannulation and therefore may possibly decrease the risk of posterior wall penetration. The authors have disclosed that they do not have any potential conflicts of interest.