A review of temporary cardiac pacing wires

This review aims to tabulate data from all available studies of temporary cardiac pacing wires. Particular aims were to determine the best route of venous access and find ways to reduce complications. The review set out to see if specialist doctors are better at inserting wires than non-specialist doctors. In addition, a contemporary study of wire insertion has been performed to compare modern practice in the UK with the previous studies.

A literature search produced 15 studies available for inclusion. Over 3700 patients from 1973 to 2004 were included. The data was tabulated and attention was given to the route of venous access, the complication rates and whether a specialist or non-specialist doctor had inserted the wire.

Internal jugular veins are associated with lowest complication rates and ease of access. Antecubital fossa veins have the highest complication rates. Complication rates are high, especially infections and failure to secure access. Specialist doctors have lower rates of complications than non-specialist doctors. Elderly patient suffer the highest complication rate. Our study showed comparable results to the previous studies.

Internal jugular veins are the preferred route for access followed by subclavian and femoral veins. The right side should be used when possible. The use of antibiotics and ultrasound probes must be contemplated for all wire insertions. Alternatives to wire insertion (especially in the elderly) must be seriously considered. Setting up an on-call rota would provide experienced doctors to reduce complication rates.