title: A comparison of steep and shallow needle trajectories in blind axillary vein puncture.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Shanghai Jiaotong University, School of Medicine, Renji Hospital, Shanghai, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Jiang
authors.forename: Xin-Rong
authors.initials: XR
authors.lastname: Gong
authors.forename: Sheng-Heng
authors.initials: SH
authors.lastname: Zhou
authors.forename: Jun
authors.initials: J
authors.lastname: Pu
authors.forename: Jia-Liang
authors.initials: JL
authors.lastname: Mao
authors.forename: Ben
authors.initials: B
authors.lastname: He
mesh_terms: D001367:Axillary Vein / Q000601:surgery*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D011677:Punctures / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: axillary vein access; blind axillary vein puncture; pacing