The use of the subclavian vein for temporary transvenous pacemaker therapy.

Temporary artificial pacing of the heart has been available clinically for the past twenty years. It was introduced as a life saving procedure for the treatment of complete arterioventricular (A-V) block and other symptomatic bradyarrhythmias. Recent developments in the field of cardiac pacemakers have resulted in pacemaker application in a wide variety of patients and the technique chosen may vary considerably with the purpose. It is of value to separate the indications for temporary pacing into urgent, semi-urgent and elective. Application of this mode of therapy requires access to the heart, a pulse generator capable of emitting a controlled electrical stimulus, and a conducting channel. In each of these areas a technology and body of knowledge has been developed. Subclavian venipuncture with catheterization is a practical procedure for the prolonged or continuous intravenous administration of different kinds of fluids. The technique of the insertion of temporary pacing lead and the point of entry vary with the indication for the procedure and the skill and experience of the operation. For the insertion of a temporary pacing electrode, several veins can be utilized; femoral, anticubical, external and interval jugular, and subclavian. Successful electrode insertion can be accomplished with relative ease through each of these veins. Selection of a vein depends upon the clinical (table: see text) situation, the availability of flouroscopic equipment and the familiarity of the operator with a specific approach.