EVALUATION OF AN ULTRASONICALLY GUIDED VENIPUNCTURE TECHNIQUE FOR THEPLACEMENT OF PERMANENT PACING ELECTRODES

We have evaluated a method of puncturing the subclavian vein in its ex trathoracic portion using an ultrasound guidance system. Seventy conse cutive patients requiring permanent pacemakers were included in the st udy. The method was successful in 56 (80%) cases (23 dual chamber syst ems) and unsuitable or unsuccessful in 24 (20%) cases (2 dual chamber systems). The time taken to achieve a successful cannulation of the ve in was similar to that taken with conventional subclavian venepuncture (average time taken for each venepuncture was 31 seconds, range 5-130 seconds). There was a significant ''learning curve'' in that nearly a ll of the unsuccessful cases were in the first half of the series. The re were no major complications Computerized Tomography (CT) confirms t hat the point of entry into the subclavian vein using this technique l ies outside the thoracic cavity, thereby minimizing the risk of pneumo thorax. This approach to the subclavian vein is an easy technique to l earn, with few immediate complications and there may fie less chance o f lead fracture due to subclavian crush in the longer term.