The axillary vein is probably the first-choice ultrasound-guided approach for a non-tunneled CICC, on all occasions where central venous access is required for intra-hospital use in patients with contraindication to PICCs.
It is important to stress that the ultrasound-guided venous approaches in the infra-clavicular area are mostly approaches to the axillary vein, and not to the subclavian vein. According to all anatomy texts, in fact, the transition between axillary vein and subclavian vein falls at the outer margin of the first coast. Since this coast is ultra-sonographically inaccessible in most cases because it is hidden by the clavicle, the venous tract that is visualized in this area should be identified as axillary vein, and not as subclavian vein. The "blind" subclavicular approach to the subclavian vein (as it was common in the 20th century) provided instead the actual puncture of the subclavian vein, since the entrance of the needle in the vein occurred behind the clavicle: obviously this technique is today absolutely to be proscribed.
Since the axillary vein has a smaller diameter than the internal jugular and the brachio-cephalic vein, it is particularly important to verify the congruity between the external diameter of the catheter and the internal diameter of the vein: for example, a 7Fr triple-lumen catheter will require an axillary vein with a diameter equal to or greater than 7mm .