Khan et al. Vascular access for transvenous pacemaker and cardioverter defibrillator implants is frequently obtained by using the cephalic cutdown technique. Difficulty in Several anatomical access points and methods to gain central venous access have been described. The axillary, cephalic, and subclavian veins, as well as the internal and external jugular veins, have all been used to insert pacemaker or ICD leads. The axillary vein has become an emerging technique for several reasons. Al-Khadra6 re-cently reported a series of 47 patients undergo-ing device implantation on warfarin therapy with a mean INR of 2.3. Central venous access techniques. ... leads via the cephalic vein… 3 Subcutaneous Implantable Cardioverter ]Defibrillator 17 Anil Rajendra and Michael R. Gold An ... Once the venous access was obtained, pacemaker leads or defibrillator leads were successfully placed via the axillary vein regardless of the number of leads, ranging from 1 to 3. Cephalic vein access is very safe for both the electrode and the patient [12 12 Benz AP, Vamos M, Erath JW, Hohnloser SH. The distal end of ... venous access in the absence of a pulmonary artery catheter or temporary transvenous pacer wire. US guided access with smaller (30mm 21G) needles was associated with the lowest access related complication rate (0/285) and higher rates of right sided and percutaneous cephalic venous access. Aggarwal RK, Connelly DT, Ray SG, Ball J, Charles RG (1995) Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems. J Cardiovasc Electrophysiol. cephalic vein (peripherally inserted central catheter: PICC). 4.1. The aim of the analysis was to analyze potential associations … Commonly implanted into the soft tissue beneath the skin in the area below the clavicle (aka prepectoral implantation) Located under the skin and fat tissue but ABOVE the pectoral muscle; The leads are attached to myocardial tissue Often, the leads of a permanent artificial pacemaker are put in the deltopectoral groove in the cephalic vein. Venous access for lead placement can be obtained, with or without the aid of a venogram, from the subclavian, the internal jugular, external jugular, axillary or cephalic vein. . Gallik DM, Ben-Zur UM, Gross JN, Furman S. Lead fracture in cephalic versus subclavian approach with transvenous implantable cardioverter defibrillator systems. Failure of the cephalic venous approach in pacemaker and defibrillator implantation is always due to the small size and difficulty in isolation of the cephalic vein. a further pacemaker procedure to identify the indication for these and to establish whether CXR had influenced ... using either the cephalic vein by cut down or direct puncture of the subclavian vein. (11) also described the successful use of the cephalic vein in the carotid patch. Using a percutaneous axillary References 1. Initial venous access and lead implantation was attempted across the left cephalic vein but aborted due to difficulty in delivering the pacing lead into the right ventricular (RV) cavity; the venous trajectory was that of a persistent left superior vena cava (SVC) draining directly into the coronary sinus. Ultrasound-guided axillary vein access is a promising alternative but there is a lack of clinical evidence supporting this technique. The axillary vein has become an emerging technique for several reasons. Venous access in CRT-P device implantations nearly always included at least one subclavian vein puncture. Axillary vein access (AVA) using fluoroscopic landmarks is an effective and safe approach for cardiac implantable electronic devices (CIEDs) implantation. 2019 Sep;30(9):1588-1593. doi: 10.1111/jce.14060. Occasionally, the cephalic vein is very small which makes it a challenge to access. Basilic Vein Cephalic Vein Assess Access Option • For arterial access, only brachial artery ... • Multiple venous access options ... when performing electrosurgery in the presence of pacemakers or implantable cardioverter defibrillators. beginners with a practical ‘how to’ guide to the first half of the implantation procedure – central venous access. Cephalic vein access. Valid data on head-to head comparisons between access via VC and VS regarding serious complications are missing. Risk for pneumothorax can be minimized by obtaining extrathoracic venous access via cephalic vein cutdown or needle puncture of the lateral axillary vein. Implantation. A total of 50 patients underwent an attempt at placement of pacemaker or implantable defibrillator leads via the axillary vein using this new technique. Br Heart J … Coding Central Venous Access Devices AHIMA 2008 Audio Seminar Series 8 Notes/Comments/Questions CVA Device Insertion: Two types: Central – puncture into the jugular, subclavian, femoral vein or in the inferior vena cava Peripheral – basilic or cephalic vein 15 CVA Device Access: Exposed catheter (external to the skin) Subcutaneous port or pump • The cephalic vein is formed from the dorsal venous arch of the hand before ascending the lateral aspect of the upper limb. Sometimes anatomical variations may limit insertion of one or several leads. A total of 50 patients underwent an attempt at placement of pacemaker or implantable defibrillator leads via the axillary vein using this new technique. The aim of this study was to assess the feasibility of a cephalic vein cutdown and venography technique for implantation of a pacemaker or ICD and to determine the causes of failure of cephalic vein cutdown. Upper-extremity deep vein thrombosis (UEDVT) accounts for ≈10% of cases of deep vein thrombosis. Valid data on head-to head comparisons between access via VC and VS regarding serious complications are missing. PROCEDURE • Venous assess • subclavian vein, the cephalic vein, or (rarely) the internal jugular vein or the femoral vein are selected. The distal end of ... venous access in the absence of a pulmonary artery catheter or temporary ... transvenous pacemaker. In literature, many techniques have been described for axillary vein access. Alternatively, target vein is accessed via direct visualization by a cut down technique (most commonly, cephalic vein). anterior and caudal fluoroscopy to achieve venous access for pacemaker device implantation. Epub 2019 Jul 23. Right heart catheterization using peripheral venous access is an approach initially ... radial side of the forearm usually drains into a cephalic venous system, although in approximately 50% of peo- ... uses of the proximal cephalic vein such as for permanent pacemakers or result in … We would encourage all centres to adopt this technique as a safe approach to venous access. It is concluded that the convenience of using the cephalic vein as a route for the insertion of transvenous pacing electrodes outweighs the small risk of major venous occlusion. Most commonly central venous access is achieved at the bedside through the subclavian, femoral, brachiocephalic and cephalic veins . Pacemakers are implanted under local anaesthetic in the subclavian region on either the left or the right side (depending on whether the patient is left or right-handed to avoid the dominant hand).. Improper use could damage insulation that may result in injury to the patient or operating room personnel. Time to access (6.8 ± 3.1 minute vs 13.1 ± 5.8 minutes, P < .001) and implantation duration was significantly shorter in the axillary group than in the cephalic group (42.3 ± 11.6 minutes vs 50.5 ± 13.3 minutes, P < .001). The subclavian route, ... achieved venous access by direct subclavian vein puncture. Ipsilateral cubital vein trocar was retained before the procedure. There was difficulty in crossing the lesion from the arm with multiple catheters and wires. Venous Access Comparison Guide - 4.15.2020 1048 Spectrum Health Contact: Grace Brown, MSN RN AGCNS-BC OCN ... the cephalic vein, basilic vein or brachial vein and then advanced through increasingly ... temporary venous pacemaker or a Single Lumen Infusion Catheter (SLIC) or cardial pacemaker and defibrillator leads using the extrathoracic subclavian vein guided by contrast venography versus the cephalic Table. However the cephalic vein has presented an alternative where venous access is faster, easier and does not risk the complications of central venous access, i.e. The cephalic vein lies on a grove just medial to the medal margin of deltoid and is sometimes marked by a skin crease. • subclavian vein is typically accessed at the junction of the first rib and the clavicle 49. Both long and short term risk reduction occurs in forgoing the traditional approaches since pneumothorax, an unfortunate short term consequence, is eliminated. A central vein (ie, the subclavian, internal jugular or axillary vein) is accessed via a percutaneous approach. 34(3), 365–369 (2011). Results Venous access of cubital vein 31/33 (94%) Patient success 33/33 (100%) No. a further pacemaker procedure to identify the indication for these and to establish whether CXR had influenced ... using either the cephalic vein by cut down or direct puncture of the subclavian vein. be achieved by cephalic vein (CV) cut-down, axillary vein (AV)/subclavian vein (SV) puncture, or a combination of these approaches [1, 2]. Ultrasound‐guided axillary access (USAA) is an effective alternative technique to conventional subclavian access for CIEDs implantation. Axillary vein puncture, Cephalic vein phlebotomy, Subclavian vein puncture, Complications with pacemaker implantation Abstract Introduction: The obtaining of venous access for implantation of implantable electronic cardiac devices (IECDs) has been traditionally made by intrathoracic subclavian vein puncture (SVP) or cephalic vein phlebotomy (CVP). Horizontal (H) incision—ease of access to both the cephalic and subclavian veins with this incision, although not as easy for the cephalic vein as the Blood loss was negligible in all cases. Ipsilateral cubital vein trocar was retained before the procedure. Transvenous access to the heart chambers is the preferable technique, commonly via a percutaneous approach of the subclavian vein, the cephalic vein (cut-down technique), or rarely the axillary vein, the internal jugular vein or the femoral vein . Deltopectoral (DP) incision—ease of access to the cephalic vein but may limit access to the subclavian vein.The operator needs to ensure the pocket is made medially to the incision; it may be more difficult to make a subpectoral pocket with this incision. Ventricular leads were more frequently inserted via the cephalic vein (2379 [60.6%]) than via the subclavian vein (1546 [39.4%]), whereas atrial leads were more frequently inserted via the subclavian vein (3404 [85.9%]) than via the cephalic vein This is a much bigger vein than the cephalic and it carries blood back from the arm to the heart. References. Operator 2 is an advanced trainee who has implanted 240 pacemakers, using the cephalic vein for 57 recent cases. Methods and results: Patients undergoing pacemaker implantation were randomized to axillary or cephalic vein access. Pacing leads may be introduced through a venotomy in an exposed vein (cephalic, jugular, iliofemoral), or venous access may be achieved using the Seldinger technique. The latter approach provides easy access to a relatively large central vein, obviating the need for surgical dissection. Transvenous access to the heart chambers is the preferable technique, commonly via a percutaneous approach of the subclavian vein, the cephalic vein (cut-down technique), or rarely the axillary vein, the internal jugular vein or the femoral vein . ture techniques compared with intrathoracic accesses. The femoral vein was also adopted in recent trials for leadless pacemaker. All the patients gave their written consent for the procedure. However, authorized RN’s may remove the venous introducer sheath left in place after their removal. 7 Grove R, Kranig W, Wolff E et al. Background: Clinicians should understand that jugulocephalic vein (JCV) variants may be occasionally found. Chan N.Y., Kwong N.P., Cheong A.P. It is a preferred vein for suitable central venous access, pacemaker and defibrillator implantation. The entry point of the needle was a one-third point to the sternoclavicular joint, and direction of the needle was toward the suprasternal … "Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic … Aim: Axillary vein access for pacemaker implantation is uncommon in many centres because of the lack of training in this technique. vein but may limit access to the subclavian vein. PURPOSE: Cephalic vein access has significant advantages over the traditional use of the subclavian and axillary veins in patients who undergo permanent pacemaker and implantable defibrillator placement. Chemoport access by nursing personnel was easy in 92% patients. A significant advantage of this technique is the ability to clearly demarcate both the anatomy of venous drainage and the lung border. Cardiac devices as pacemakers and defibrillators must be implanted through the upper veins to reach the heart. Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown. Often, the leads of a permanent artificial pacemaker are put in the deltopectoral groove in the cephalic vein. 1 Veins considered to be "deep" classically have a corresponding named artery. Venous access for lead placement can be obtained, with or without the aid of a venogram, from the subclavian, the internal jugular, external jugular, axillary or cephalic vein. Pacing Clin. However, cephalic veins exhibit a wide array of developmental variations in terms of formation, course, and termination. The cephalic vein pierces the fascia to enter the deeper aspect of the pecoralis major and enter the axillary vein. Comparative descriptions of cephalic cutdown technique, conventional subclavian, extrathoracic subclavian and axillary venous punctures are provided, with tips for technique selection and troubleshooting. PACE through the cephalic vein. Aggarwal RK, Connelly DT, Ray SG, Ball J, Charles RG (1995) Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems. pneumothorax. A primary access via the cephalic vein was present in 15 patients (27%). The vein may be used for intravenous access, as large bore cannula may be easily placed. receives the lateral cephalic vein [10]. Venous access for permanent pacemaker lead implantation is obtained by cephalic venotomy or by subclavian/axillary puncture. Ann Thorac Surg 1986; 1991; 14:241-243. TSE, H.–F.,et al. A new 5. , The cephalic vein is another common access for pacemaker implantation, but this vein is too small and not suitable for multiple leads insertion and implantable cardioverter-defibrillator implantation. Ultimately, using Sixty patients were in sinus rhythm, 13 were in atrial fibrillation, and 26 had a previous pacemaker (n = 21) or defibrillator (n = 5). On deployment of the lead in the right ventricular apex, the patient immediately complained of severe back, neck and chest pain which was sharp in nature and accompanied by a sudden drop in blood pressure. In devices with three leads, while they can all be placed via the cephalic vein, it is generally preferred to place the smaller of the leads in the axillary or subclavian vein. We used the 18-G needle to search for the subclavian vein with X-ray fluoroscopy at the point of clavicle. All procedures were successful. From a semantics point of view – this also includes the extrathoracic part of the subclavian vein. 1. Due to ease of access and low complication rates, the cephalic, subclavian, and axillary veins are the most common veins used in clinical practice for cardiac device implantations. Pneumothorax should be drained with a chest tube. Using a percutaneous axillary References 1. The cephalic vein in the upper arm may be robust or diminutive. The moderately large cephalic vein (arrow) lies in the dissected deltopectoral groove and has ligatures placed proximally and distally. Cephalic vein (CV) cutdown is a safe and effective technique for right atrial and ventricular lead placement in patients receiving pacemakers and implantable cardioverter defibrillators (ICDs). Creta A(1)(2), Providência R(1), Finlay M(1). A pacemaker is fitted by a trained cardiologist in a cardiac catheterisation laboratory. Venous access that is minimally invasive is a prerequisite for lead insertion of cardiac implantable electronic devices (CIEDs) such as permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy (CRT). The final position was lateral in 59 patients, posterolateral in 33, posterior in 4, and anterolateral in 3. Ong LS, Barold SS, Lederman M, et al. Figure 5.7. Procedure: We access the axillary vein under fluoroscopy. This vein cannot be seen directly with simple dissection. The cephalic vein cut-down method has been found to correlate with a lower incidence of complications than subclavian vein puncture [5]. A potential alternative to the saphenous is the cephalic vein (CV), which has been utilized in the deltopectoral triangle for central access, pacemaker implantation, and defibrillator implantation (2). On the next day, patient complained of one episode of syncope. The axillary, cephalic, and subclavian veins, as well as the internal and external jugular veins, have all been used to insert pacemaker or ICD leads. Cephalic vein cut-down technique or extra thoracic axillary vein puncture provides safer alternatives for central venous access in patients undergoing permanent pacemaker implantation and such be considered as fist line approach [5,6]. However, it may result in a higher radiation exposure. Pacemaker pocket was created below the clavicle. ... access through a central cephalic vein is possible. Alternatively, target vein is accessed via direct visualization by a cut down technique (most commonly, cephalic vein). Materials and methods: We investigated anatomical variants of the cephalic vein in 55 human cadavers during a gross anatomy course at our medical school. bition response, rate-adaptive pacemaker (VVIR) pacemaker was inserted via the left cephalic vein using an active fix lead. 1. The aim of this study was to assess the feasibility of a cephalic vein cutdown and venography technique for implantation of a pacemaker or ICD and to determine the causes of failure of cephalic vein cutdown. Note: Axillary vein access denotes any venous access lateral to the medial border of the first rib. TSE, H.–F.,et al. Pneumothorax, resulting from inadvertent needle puncture of the pleura during placement of the leads, complicates approximately 2% of pacemaker implant procedures. [1] , [2] Procedural success and complication rate is closely related with the operator experience and the anatomy of the operation area. Br … Implantable pacemaker. The number of procedures for cardiac implantable electronic device (CIED) placement continues to increase.1 Many reports have examined variations of CIED implantation techniques.2–4 Of course, no account can totally cover all of the implant techniques and variations used by different operators; as with any practical skill, written descriptions cannot replace the practical experience of a skilled implanter.2 A CIED implantation technique can be divided into several stages. Occlusion of the subclavian vein associated with cephalic vein pacemaker electrodes. The most commonly used techniques are the cephalic vein (CV) “cut-down” method and direct needle puncture of the subclavian vein (SV) or axillary vein (AV) (ie, the Seldinger technique).3,5 The CV is located in the deltopectoral grove, penetrating the clavipectoral fascia to join the axillary vein medial to The aim of the analysis was to analyze potential … Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown. Symptoms and imaging studies guide the diagnosis of superficial vein thrombosis. August 01, 2015 [ MEDLINE Abstract] Keeping in common use, axillary access is the preferred term as – extrathoracic subclavian vein access is … However, there has been a growing trend of utilizing this approach to obtain venous access for device implantation among operators. present and look for right sided pneumothorax even when the cephalic vein is used for access.
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