A variation on the introducer technique for unlimited access to the subclavian vein

An adaptation of the sheath set approach for permanent transvenous electrode placement has been carried out in fifteen patients. At the time of lead insertion, the sheath guide wire is left in place. If a second lead is desired or lead exchange becomes necessary, a second sheath is applied to the retained guide wire and a new lead inserted, thus avoiding a second subclavian puncture or new venous cutdown. This in effect offers a limitless access to the central venous system as long as the guide wire is left in place. This adaptation is especially suited for dual chamber pacing, where multiple leads may be required.