Extrathoracic Subclavian Venipuncture Under Ultrasound Guidance

Orihashi, Kazumasa; Imai, Kyoichi; Sato, Katsutoshi; Hamamoto, Masaki; Okada, Kenji; Sueda, Taijiro

doi:10.1253/circj.69.1111

Cited by 43 publications

(31 citation statements)

References 7 publications

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“…The use of US‐guided venous access for CIED implantation procedures in the adult population is becoming more commonplace with high success and low complication rates. Several authors have described US‐guided access, either axillary or subclavian vein, in adult patients after pocket creation with a high success rate (65%‐86% success on the first attempt) and no access‐related complications . Others favor the approach of US‐guided access, either axillary or subclavian, followed by pocket creation .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided axillary venous access for pediatric and adult congenital lead implantation

Clark

Janson

Nappo

et al. 2018

Pacing Clinical Electrophis

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Background Axillary venous access with ultrasound guidance for pediatric transvenous lead implantation may reduce risks for pneumothorax and hemothorax. The objective was to retrospectively evaluate ultrasound‐guided axillary vein access as an alternative to the subclavian approach. Methods The technique consists of ultrasonographic identification of the axillary vein at the deltopectoral groove after initial contrast venography. A micropuncture kit is used for initial ultrasound‐guided percutaneous access with fluoroscopic confirmation of wire position. Pocket creation is performed, and sheath insertion and lead implantation proceed as usual. Demographic, procedural, and radiation exposure data were collected and analyzed. Results Sixteen patients (median age = 13 years, 8‐50 years; median weight = 56 kg, 29‐77 kg) underwent lead implantation; two additional patients required fluoroscopy due to poor acoustic windows (89% success). Fifteen of 21 leads (71%) were ventricular; 50% of implants were pacemakers, and 31% were dual chamber. Median time to venous access was 13 min (interquartile range (IQR) = 9.25‐20.25) and median implant procedure time was 156 min (IQR = 112‐172). Median fluoroscopy time was 18.0 min (IQR = 11.9‐29.6), median air kerma was 9.0 mGy (IQR = 3.0‐28.5), and median dose‐area product was 30.2 Gy‐cm2 (IQR = 16.1‐234.5). One patient required generator pocket revision 2 days postprocedure without lead dislodgement. There were no other complications encountered. Conclusions Transvenous pacemaker and implantable cardioverter‐defibrillator lead implantation in the pediatric and adult congenital population through ultrasound‐guided axillary venous access is safe and efficacious. This technique may provide a low‐risk alternative for vascular access for pediatric implantation procedures.

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Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided axillary venous access for pediatric and adult congenital lead implantation

Clark

Janson

Nappo

et al. 2018

Pacing Clinical Electrophis

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“…12 More recently, reports on accessing the axillary or subclavian vein using ultrasound guidance demonstrate increased safety, with some studies reporting a zero incidence of pneumothorax. 13 The safety profile of ultrasound-guided transpectoral axillary vein catheterization has not been established yet. Our case series demonstrates in a small number of cases that this alternate method of central venous access with real-time visualization near the point where the axillary vein terminates into the subclavian vein was done safely with no complications.…”

Section: Discussionmentioning

confidence: 99%

Real-time Multimodal Axillary Vein Imaging Enhances the Safety and Efficacy of Axillary Vein Catheterization in Neurosurgical Intensive Care Patients

Uhlenkott¹,

Sathishkumar

Murray

et al. 2013

Journal of Neurosurgical Anesthesiology

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This series illustrates new and useful aspects of ultrasound use in transpectoral axillary vein catheterization: it requires minimal additional training; it combines the real time, in-plane technique with transverse, longitudinal, and Doppler color flow images; and it is used safely in the critically ill neurosurgical patient. The data on infraclavicular central venous catheters indicate decreased line sepsis, arterial punctures, and venous thrombosis while improving nursing care and patient comfort. This technique's potential for decreasing the risk of pneumothorax may make it a reasonable option for many critically ill patients in whom other central venous catheter approaches may not be ideal.

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“…A physician specializing in cardiovascular internal medicine may find this cut‐down method to be more challenging than a surgeon specializing in cardiovascular surgery would, as this is a relatively invasive method. Although ultrasound‐guided puncture has recently been recommended by experts in pacemaker‐related academic societies and research groups, this method requires expertise in differentiating the subclavian vein from the subclavian artery and in analyzing diagnostic ultrasound images, a catheterization laboratory that is equipped with an ultrasound instrument and other necessaries, and an aseptic technique [6]. Due to the relatively complicated nature of this procedure, the ultrasound‐guided puncture method is not commonly utilized.…”

Section: Discussionmentioning

confidence: 99%

Novel extrathoracic puncture techniques for pacemaker lead insertion: Pitfalls of the conventional extrathoracic puncture method

Sawasaki

Sato

Takayama

et al. 2012

Journal of Arrhythmia

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IntroductionSurgical procedures for pacemaker implantation vary among facilities. The extrathoracic venous puncture method has been utilized for lead insertion, although patients' body movements can displace the targeted vein from the area into which a contrast agent has been injected for imaging. Failed punctures cause edema around the puncture site, spasm, or venous collapse due to bleeding, which may render another puncture impractical. To overcome these problems, we report a new technique for the extrathoracic puncture method.Methods and resultsFrom April 2007 through March 2011, we performed 35 new dual chamber pacemaker implantation procedures. This study compared a conventional puncture group (from April 2007 through March 2009; Group A) with a catheter‐guided puncture group (from April 2009 through March 2011; Group B). We analyzed procedure time and procedure‐related complications in each group. The procedure time was 138.6±41.8 min in the conventional puncture group (Group A) and 109.8±23.2 in the catheter‐guided puncture group (Group B). There was a significant reduction in the procedure time in the catheter‐guided puncture group (Group B) compared with the conventional puncture group (Group A; p=0.016). No patients in either group had pneumothorax, hematoma, or any other complications.ConclusionOur puncture method involving catheter insertion appears to be safe and effective.

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Extrathoracic Subclavian Venipuncture Under Ultrasound Guidance

Cited by 43 publications

References 7 publications

Ultrasound‐guided axillary venous access for pediatric and adult congenital lead implantation

Ultrasound‐guided axillary venous access for pediatric and adult congenital lead implantation

Real-time Multimodal Axillary Vein Imaging Enhances the Safety and Efficacy of Axillary Vein Catheterization in Neurosurgical Intensive Care Patients

Novel extrathoracic puncture techniques for pacemaker lead insertion: Pitfalls of the conventional extrathoracic puncture method

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