Abstract 14192: Complications Associated with Venipuncture During Cardiac Device Implantation are Significantly Reduced with Utilization of Micropuncture Needle
Introduction: Complications after vascular access for pacemaker implantation such as hematoma, pneumothorax, hemothorax, and arterial puncture range from 6.2 to 10.7% using a standard 18 gauge needle and modified Seldinger technique. We assessed if using a 21 gauge micropuncture needle set would result in decreased complication rate when compared to standard technique.
Methods: Patients (n=148) underwent cardiac device implantation by a single teaching attending supervising four different fellows. Venopuncture was performed under fluoroscopic guidance with either a standard 18 gauge or a micropuncture 21 gauge needle. When the micropuncture needle was utilized, a 0.018 guide wire was placed and the needle was exchanged for a 5 Fr introducer. Through a standard 5 Fr introducer, a 0. 035 J tipped guide wire was introduced. Placement of venous sheaths and pacing/ICD leads proceeded through accepted techniques. Variables included demographics, clinical status, and complications. Statistical analysis included cross tabs with Fisher Exact.
Results: Patients had a mean age of 75.5 ±10.7 years with 65% being male and 28% diabetic. Body mass index was 28.8 ±7 kg/m2. Plavix was used by 28% and Aspirin was used in 70% of patients. A micropuncture needle was used in 28% of cases. Pacemakers were implanted in 33%, implanted cardiac defibrillators in 18%, biventricular pacemakers in 16%, and biventricular cardiac defibrillators in 33% of cases. Total complications occurred in 7.43% of cases with 2.03% pneumothorax, 1.36% hemothorax, 0.68% chest tube placement, and 4.5% blood transfusion. Complications were significantly different between cases with a standard 18 gauge needle (10%) and a micropuncture needle (0%; p = 0.034). Complications were more common in diabetics (20%) compared to non diabetics (3.7%; p= 0.012). No other variables were different between cases with complications and without complications.
Conclusion: Our results indicate that the use of a micropuncture needle to gain subclavian vein vascular access was associated with a statistically significant decrease in complications when compared to the use of a standard 18 gauge needle. This quality of care improvement has led to decreased use of adverse outcomes and healthcare resources.
- © 2011 by American Heart Association, Inc.