Cardiac Pacing and Device Therapy by David R. Ramsdale & Archana Rao

Author:David R. Ramsdale & Archana Rao
Language: eng
Format: epub
Publisher: Springer London, London

Fig. 13.35Landmarks for subclavian vein puncture

When the subclavian vein is entered, venous blood will be easily aspirated from this large vein. The syringe is removed (taking care not to move the needle) and a soft-tipped J-shaped guidewire is then inserted through the needle and into the subclavian vein and advanced through the left brachiocephalic vein into the SVC. The needle is then removed and a sheath within which there is a tapered vessel dilator is passed over the wire into the vein. Care must be taken to ensure that the guidewire always extends outside of the sheath during its insertion in order to avoid losing the guidewire within the venous system. The guidewire and dilator are then removed, leaving the sheath in situ, and the pacing lead is then passed through the sheath along the same route to the SVC and right atrium. Ensuring a head-down position during insertion and blood flow out of the needle and sheath during insertion of the guidewire and pacing lead, respectively, should prevent air embolism from occurring. An alternative approach should be considered if the patient has received thrombolytic therapy, is anticoagulated, or if the contralateral subclavian vein has been used and permanent pacing is likely to be required.

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