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Related Concept Videos

Assessment of apical pulse01:17

Assessment of apical pulse

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Assessing the Apical Pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
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Assessment of apical radial pulse01:25

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Apical-Radial (A-R) Pulse Assessment
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
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Updated: May 13, 2025

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Standardised procedure for pacemaker axillary vein puncture.

Bing Ji1, Yu Mao1, Xue-Bo Liu1

  • 1Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.

BMC Cardiovascular Disorders
|April 15, 2025
PubMed
Summary
This summary is machine-generated.

Fluoroscopy-guided axillary vein puncture for pacemaker implantation is feasible and safe, with success influenced by patient anatomy like BMI and clavicle angles. This technique offers a viable option, especially in resource-limited settings.

Keywords:
Axillary vein accessBody mass index (BMI)Clavicle-first rib angleFluoroscopic guidancePacemakerRight anterior oblique

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Area of Science:

  • Cardiovascular Interventions
  • Medical Imaging
  • Anatomical Studies

Background:

  • Axillary vein access is a promising alternative to subclavian venous access for pacemaker implantation, potentially reducing infection risk and improving success rates.
  • Standardized protocols for fluoroscopy-guided axillary vein puncture are currently lacking.

Purpose of the Study:

  • To evaluate the feasibility of a simplified fluoroscopic technique for axillary vein puncture.
  • To identify anatomical and clinical predictors of procedural success for axillary vein access.

Main Methods:

  • Retrospective cohort study of 178 patients undergoing pacemaker implantation.
  • Patients stratified by fluoroscopic puncture technique: RAO 30°, Caudal 35°, or vein-guided.
  • Analysis of demographic data, comorbidities, smoking status, and radiographic parameters (subclavian fat thickness, clavicle-first rib angle).

Main Results:

  • High success rate of 94.9% (169/178) for axillary vein puncture without venography.
  • Predictors of success included sex-specific anatomy, BMI ≥ 23.84 kg/m², and clavicle-first rib angles.
  • Low complication rate of 1.69%, with no severe events like pneumothorax or lead dislodgement.

Conclusions:

  • Fluoroscopy-guided axillary vein puncture success is critically dependent on patient-specific anatomy (sex, BMI, clavicle-first rib relationships, smoking status).
  • The standardized protocol demonstrated high efficacy and safety without ultrasound, proving useful in resource-limited environments.