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Axillary vein access using ultrasound guidance, Venography or Cephalic Cutdown-What is the optimal access technique
Lloyd Davis1,2,3, William Chik1,2,3,4, Saurabh Kumar1,2,3
1Department of Cardiology Westmead Hospital Sydney New South Wales Australia.
Insights
Ultrasound-guided central vein access for cardiac implantable electronic devices offers significant benefits. This method reduces radiation, avoids contrast dye, and minimizes risks like pneumothorax, making it a preferred choice for most patients.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Access
Background:
- Central vein access is crucial for implanting cardiac devices.
- Traditional methods include cephalic vein cutdown and axillary vein cannulation.
- These methods carry risks and may require imaging guidance.
Purpose of the Study:
- To review and compare different central vein access techniques for cardiac device implantation.
- To highlight the advantages and disadvantages of each approach.
- To emphasize the benefits of ultrasound guidance.
Main Methods:
- Literature review of central vein access methods.
- Discussion of cephalic vein cutdown, venography, and ultrasound-guided axillary vein cannulation.
- Analysis of benefits and hazards associated with each technique.
Main Results:
- Each approach has unique benefits and risks.
- Ultrasound guidance significantly reduces radiation exposure and the need for contrast.
- Ultrasound minimizes risks such as pneumothorax and arterial puncture.
Conclusions:
- Operator skill and patient factors must guide the choice of access technique.
- Ultrasound-guided venous access is a safe and effective option for most patients.
- Training in all approaches is essential for managing patient variability.
Abstract:
We reviewed the different approaches used for central vein access during insertion of cardiac implantable electronic devices. The benefits and hazards of each approach (cephalic vein cutdown, axillary vein cannulation using venography and ultrasound) are discussed. Each approach has its advantages and hazards that need to be considered for the individual patient and balanced against the skills of the operator. The benefits of ultrasound guided venous access in reducing radiation exposure to the patient and implanter, avoiding the need for angiographic contrast and in minimizing the risk of pneumothorax and inadvertent arterial puncture are highlighted. Trainees should be taught each approach to deal with patient variability. Ultrasound guidance should be considered as a mainstream option for most patients.
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