title: Wireless Ultrasound-Guided Axillary Vein Cannulation for the Implantation of Cardiovascular Implantable Electric Devices.
abstract: BACKGROUND
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Ultrasound-guided axillary vein cannulation using a wireless transducer for the implantation of CIEDs is a feasible, fast, and safe method.
authors.affiliation: Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Franco
authors.affiliation: Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodriguez Muñoz
authors.affiliation: Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Matía
authors.affiliation: Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernandez-Madrid
authors.affiliation: Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Carbonell San Román
authors.affiliation: Pediatric Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Sánchez
authors.affiliation: Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Zamorano
authors.affiliation: Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Moreno
mesh_terms: D000368:Aged; D001367:Axillary Vein / Q000648:ultrastructure*; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D014159:Transducers; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation* / Q000379:methods; D059015:Wireless Technology / Q000295:instrumentation*
keywords: axillary vein; cannulation; cardiac stimulation device; electrophysiology; pneumothorax; wireless ultrasound