Comparison of Brachial Vein Versus Internal Jugular Vein Approach for Access to the Right Side of the Heart With or Without Myocardial Biopsy

Ultrasound-guided antecubital vein approach for right heart catheterisation in a Brazilian tertiary centre

“…In our cohort, attempts to access antecubital veins were successful in 96% of the cases and the five observed failures occurred within the first 50 attempts to perform right heart catheterisation from antecubital veins in our institution, suggesting that our unsuccessful attempts might, in fact, represent our learning curve in obtaining antecubital venous access under ultrasound guidance. Similarly, Harwani et al 8 reported 100% success rate with ultrasound-guided peripheral venous access strategy for both right heart catheterisations and endomyocardial biopsies. Notably, our protocol, as well as Harwani et al ’s,8 which similarly to ours used ultrasound guidance to obtain antecubital venous access, provides information on the adoption of antecubital venous approach as the preferred route for right heart catheterisations.…”

“…Similarly, Harwani et al 8 reported 100% success rate with ultrasound-guided peripheral venous access strategy for both right heart catheterisations and endomyocardial biopsies. Notably, our protocol, as well as Harwani et al ’s,8 which similarly to ours used ultrasound guidance to obtain antecubital venous access, provides information on the adoption of antecubital venous approach as the preferred route for right heart catheterisations. The previous series of right heart catheterisations from the ‘forearm approach’ included either individuals with palpable/visible antecubital veins or individuals in which forearm venous access had been obtained before the procedure 6 7 9–14.…”

“…Although right heart catheterisation is considered a low-risk procedure with low incidence of adverse events, local vascular complications are responsible for the majority of those events and there are established site-specific risks 2. Further, previous small studies demonstrated reduced incidence of vascular complications, early ambulation and greater comfort to patients with the antecubital venous approach for right heart catheterisation 6–13…”

“…The data supporting the utilisation of the antecubital venous approach for right heart catheterisation are mainly derived from a series in which eligibility for such approach was based on visualisation/palpation of the antecubital veins 6–15. Hence, the applicability of the antecubital venous approach for the highly heterogeneous populations usually referred for right heart catheterisation is unclear.…”

Myocardial biopsy: techniques and indications

“…Alternative approaches include femoral vein, using longer bioptomes usually within a long sheath and less commonly, subclavian and brachial veins 12. Left internal jugular vein access is complicated by the requirement to negotiate two curves in order to enter the right ventricle.…”