Ultrasound Guided Venous Access for Cardiac Devices: Defining Learning Curve for Safety, Efficacy, and Radiation Exposure.

IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2025-09-01 Epub Date: 2025-07-31 DOI:10.1111/pace.70021
Anish N Bhuva, Hnin Zaw, Adam Graham, Amal Muthumala, Philip Moore, Mehul Dhinoja
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Abstract

Background: There is limited real-world experience of the learning curve for ultrasound (US) guided axillary venous access for cardiac device implantation, and it is usually performed before cutaneous incision. We investigated the learning curve, radiation exposure, safety, and efficacy of US-guided venous access in standard workflow.

Methods: US-guided access was performed by an experienced electrophysiologist with no prior application of the technique by using a standard vascular US probe and minimal modification to workflow. The learning curve was evaluated using access time (needle-to-wire time). Complications were recorded until hospital discharge, and efficacy was defined by procedural success. Radiation dose savings were estimated based on fluoroscopy time for access, and a control group underwent conventional fluoroscopy landmark-guided access (n = 44 punctures).

Results: 147 US-guided punctures were performed in 74 patients for one (8%), two (71%), or three (17%) leads, or upgrades (4%). Access was successful in 97% (n = 72). There were no access-related peri-procedural complications. First US-guided access time was 30 seconds (interquartile range [IQR]: 17,60), and was similar to fluoroscopy-guided access time (43 seconds, IQR: 24,58; p = 0.45). Access time stabilized after 45 procedures, decreasing from 81 (IQR: 61,90) to 16 seconds (IQR: 10,20) from the first to the last 15 procedures (p < 0.001). 96% (n = 69) did not require fluoroscopy. 4% (n = 3) required 1 second fluoroscopy to confirm wire position after difficult passage. Estimated radiation exposure saving from controls was 30 seconds (IQR: 15,78) of fluoroscopy, resulting in 0.4 (IQR: 0.26,1.7) mGy cumulative skin dose, equivalent to 1.3 (95% confidence interval: 0.26,1.45) patient chest radiograph radiation exposure.

Conclusion: US-guided axillary venous access for cardiac device implantation is feasible in a standard workflow and reduces radiation exposure. The learning curve time is acceptable, and the procedure is safe, even during training.

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超声引导心脏装置的静脉通路:定义安全性、有效性和辐射暴露的学习曲线。
背景:超声(US)引导下腋窝静脉进入心脏装置植入的学习曲线的实际经验有限,通常在皮肤切口之前进行。我们研究了在标准工作流程中使用us引导静脉通路的学习曲线、辐射暴露、安全性和有效性。方法:由经验丰富的电生理学家使用标准血管超声探头和对工作流程的最小修改,在没有事先应用技术的情况下进行超声引导。使用接触时间(针头到导线的时间)评估学习曲线。记录并发症直至出院,并以手术成功来定义疗效。根据透视进入的时间估计辐射剂量节约,对照组接受常规透视地标引导进入(n = 44次穿刺)。结果:74例患者进行了147次穿刺,分别为1次(8%)、2次(71%)或3次(17%)导联或升级(4%)。访问成功率为97% (n = 72)。术中未见与通路相关的并发症。首次超声引导入路时间为30秒(四分位间距[IQR]: 17,60),与透视引导入路时间相似(43秒,IQR: 24,58;P = 0.45)。45次手术后访问时间稳定,从第一次手术到最后15次手术,访问时间从81秒(IQR: 61,90)减少到16秒(IQR: 10,20) (p < 0.001)。96% (n = 69)不需要透视检查。4% (n = 3)患者在困难通过后需要1秒透视确认导线位置。估计从对照组中节省的辐射暴露为30秒(IQR: 15,78)的透视检查,导致0.4 (IQR: 0.26,1.7) mGy的累积皮肤剂量,相当于1.3(95%可信区间:0.26,1.45)患者胸片辐射暴露。结论:在标准的工作流程中,us引导下的腋窝静脉通道用于心脏装置植入是可行的,并减少了辐射暴露。学习曲线时间是可以接受的,过程是安全的,甚至在训练期间也是如此。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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