Franco Eduardo, Rodriguez Muñoz Daniel, Matía Roberto, Hernandez-Madrid Antonio, Carbonell San Román Alejandra, Sánchez Inmaculada, Zamorano Jose, Moreno Javier
Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
Pediatric Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
J Cardiovasc Electrophysiol. 2016 Apr;27(4):482-7. doi: 10.1111/jce.12917. Epub 2016 Feb 12.
Ultrasound guidance for vascular cannulation seems safer and more effective than an anatomical landmark approach, though it has not gained widespread support partly due to workflow interference of wired probes. A wireless ultrasound transducer (WUST) may overcome this issue. We report the effectiveness, time consumption, and safety of the first-in-human experience in axillary vein cannulation guided with a novel WUST for the implantation of cardiovascular implantable electric devices (CIEDs).
After a one-month training period, we routinely performed WUST-guided puncture to all first implants, prospectively registering data from the first 50 patients. We analyzed the time needed for preparing the WUST and for achieving each vein cannulation, and the rate of unsuccessful or accidental arterial punctures and complications. WUST-guided axillary vein access was successful in 49 out of 50 patients, totaling 86 cannulated veins. Median WUST preparation time was 55 [44-62] seconds and median time needed for each venous cannulation was 56 [36-71] seconds. A total of 84.9% of the veins were cannulated at the first attempt. There were 7 unsuccessful puncture attempts and 1 accidental arterial puncture. No pneumothorax, hemothorax, or nervous injury occurred in the 49 successfully cannulated patients. The unsuccessful one (distal subclavian occlusion) developed a minor local subcutaneous emphysema with no confirmed radiologic pneumothorax, not requiring intervention. During a follow-up of 2.5 ± 1.1 months, a patient developed a pocket infection, with no other significant complications.
Ultrasound-guided axillary vein cannulation using a wireless transducer for the implantation of CIEDs is a feasible, fast, and safe method.
超声引导下的血管穿刺置管似乎比解剖标志法更安全、更有效，不过由于有线探头对工作流程的干扰，它尚未获得广泛支持。无线超声换能器（WUST）可能会克服这一问题。我们报告了首例使用新型WUST引导进行腋静脉穿刺置管以植入心血管植入式电子设备（CIED）的人体试验的有效性、耗时及安全性。
经过为期一个月的培训期后，我们对所有首次植入患者常规进行WUST引导下的穿刺，并前瞻性记录前50例患者的数据。我们分析了准备WUST以及完成每次静脉穿刺所需的时间，以及穿刺失败、意外动脉穿刺和并发症的发生率。50例患者中有49例WUST引导下的腋静脉穿刺成功，共穿刺了86条静脉。WUST的中位准备时间为55[44 - 62]秒，每次静脉穿刺所需的中位时间为56[36 - 71]秒。84.9%的静脉在首次尝试时即穿刺成功。共有7次穿刺尝试失败，1次意外动脉穿刺。49例穿刺成功的患者未发生气胸、血胸或神经损伤。穿刺失败的那例患者（锁骨下静脉远端闭塞）出现了轻微的局部皮下气肿，经影像学检查未证实有气胸，无需干预。在2.5±1.1个月的随访期间，有1例患者发生了囊袋感染，无其他严重并发症。
使用无线换能器进行超声引导下的腋静脉穿刺置管以植入CIED是一种可行、快速且安全的方法。
