A Comparison of Steep and Shallow Needle Trajectories in Blind Axillary Vein Puncture

Abstract

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. 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. 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). 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.