Conclusion
This step-by-step guide describes an ultrasound guided vascular access approach utilizing both short and long axis views for optimal visualization of the axillary vasculature, expected surrounding structures, and the approach of the needle tip as it tents and enters the front wall of the axillary vein. The description and videos also highlight the benefit of long axis ultrasound viewing angle in seeing the tip of the access needle and aiding the operator to angle the needle tip to catch the front wall of the vein, which augments the ease of a twisting motion cutting into the vein. This will hopefully aid the reader in adopting a technique that is efficient and provides an extremely safe route of access for all CIED implantation.