A Comparison of Steep and Shallow Needle Trajectories in Blind Axillary Vein Puncture
Authors Meng Jiang and Xin-Rong Gong contributed equally to the manuscript.
Funding source: This work was supported by the Natural Science Foundation of China [grant numbers 30800453 and 81270206], the Natural Science Foundation of Shanghai [grant number 12ZR1417600], the Shanghai Rising-Star Program [grant number 10QA1404500], and the Shanghai Med-X program [grant number YG2010MS29]. We also thank the K. C. Wang Research Foundation.
Previously developed techniques for pacemaker lead introduction usually require some form of image guidance to facilitate the axillary vein puncture process. The existing blind vein puncture methods have not gained widespread acceptance. We aimed to investigate whether our blind vein puncture approach is effective and safe.
We compared the patient characteristics and clinical outcomes of 600 consecutive patients who underwent different blind axillary vein puncture procedures. In group I, a steep needle puncture method was used, whereas in group II a shallow needle puncture technique was used.
The shallow needle puncture method was associated with a higher success rate than the steep needle puncture method (94% vs 54%, P < 0.00001). The shallow needle puncture method was also associated with a much shorter puncture and lead insertion time (7 ± 2 minutes vs 10 ± 3 minutes, P = 0.02).
Our shallow needle puncture technique does not require any extra equipment. In addition, this method is effective and safe and may be used as the initial attempt for venous access during pacemaker implantation.