Extrathoracic Subclavian Venipuncture Under Ultrasound Guidance

BACKGROUND: Cardiac pacemaker and defibrillator leads are inserted through extrathoracic subclavian venipuncture using ultrasound (US) guidance, but there can be complications. The purpose of this study was to investigate a safer and improved implanting procedure. METHODS AND RESULTS: Venipuncture guided by US with a 7.5 MHz convex transducer was performed to implant 32 leads in 18 patients. US enabled identification and location of the vein and needle tip during puncture and clarified the reasons for unsuccessful venipuncture. Venipuncture was successful on the second attempt or within 2 min in 90.6% (29/32) and 84.4% (27/32) of lead placements, respectively, although the vein was small (mean, 7.8 mm), deep (mean, 22.7 mm), and required a large angle of entry (mean, 52.4). The subclavian artery or lung was adjacent to the vein in 50.0% and 27.8% of cases, respectively. The flexible wall of the vein interfered with the penetration of the needle in 33.3% of cases. It was often difficult to locate the needle tip because of poor visualization. CONCLUSIONS: Ultrasound guidance of subclavian venipuncture enables a safe and time-saving procedure by visualizing not only the needle but also the vein and surrounding structures, although further modifications of the needle are needed for better visualization.