title: Ultrasound-guided venous access for permanent pacemaker leads.
abstract: BACKGROUND
  Existing methods of venous access for permanent pacemaker leads have disadvantages. We documented learning times for ultrasound-guided lead implantation and compared them with cephalic venotomy technique.
  
  
  METHODS
  Two implanters learnt ultrasound-guided technique by implanting consecutive pacemaker patients. When procedural times stabilized, we reverted to our normal cephalic approach. We measured lead placement time and screening time from skin incision until all leads were placed in superior vena cava were measured.
  
  
  RESULTS
  Initial strategy adopted was ultrasound for 60, then cephalic for 38 patients. There were no significant differences between groups in baseline characteristics or number of leads implanted. Lead placement and screening times were significantly shorter for ultrasound, despite inclusion of all learning cases. There was a high success rate for both strategies (88% ultrasound, 87% cephalic). There was significantly greater use of pressure dressings with ultrasound, but no difference in pocket hematoma or pneumothorax. There was a trend for more predictable lead implant times with ultrasound and fluoroscopy times were shorter and more predictable. Independent predictors of lead placement time were body mass index, operator, initial strategy (ultrasound vs cephalic), and procedure number.
  
  
  CONCLUSIONS
  Ultrasound-guided venepuncture for placement of permanent pacing leads is quick to learn and achieves faster lead placement times with shorter and more predictable fluoroscopy time when compared with the cephalic venotomy technique.
authors.affiliation: Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: David G
authors.initials: DG
authors.lastname: Jones
authors.forename: Martin K
authors.initials: MK
authors.lastname: Stiles
authors.forename: James T
authors.initials: JT
authors.lastname: Stewart
authors.forename: Guy P
authors.initials: GP
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D001367:Axillary Vein / Q000601:surgery*; D004567:Electrodes, Implanted; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D016748:Venous Cutdown / Q000379:methods*