Clinical Application Study Of "Simple Blind Method" Guided Axillary Vein Puncture

Objective: Choosing an appropriate central venous approach is the key to successful cardiac pacemaker surgery.Axillary vein has become the preferred alternative to central venous approach due to its unique advantages.Blind puncture is the main development direction of current axillary vein puncture due to its simple operation and no need for Xrays or contrast agents.This article aims to study the effectiveness and safety of "simple blind method" to guide axillary vein puncture and implant pacemaker lead,and to find a simple,safe and repeatable axillary vein puncture method.Methods: Selected 382 patients with pacemaker implantation in the Department of Cardiology,Affiliated Hospital of Yunnan University from March 2017 to December 2019,and collected basic clinical information such as gender,age,body mass index(BMI),and main diagnosis.All patients used the "simple blind method" to puncture the axillary vein to obtain venous access,and the operations were performed by the same technique by a skilled surgeon.Among them,from March 2017 to January 2018,patients(n=119)used "simple blind method" to locate and mark the axillary vein before surgery,and then use ultrasound to locate and mark the shape of the axillary vein,and observe the actual puncture point during the operation The distance from the ultrasound positioning point;from February 2018 to December 2019,the patient(n=263)will not undergo ultrasound positioning before surgery,and directly use the "simple blind method" for puncture.The vertical distance from the patient’s puncture point to the clavicle,the number of punctures,the success rate of puncture,and the complications related to the operation were collected.The patients were followed up for 1 year to observe the wear and tear of the pacemaker electrode and the working parameters of the pacemaker.Result: 1.Baseline data: Among the 382 patients,the average age of the patients was 70.4±12.6 years,260 were male patients(68.1%),and the average age was 70.9±12.5 years;122 cases(31.9%)were female patients,and the average age was 69.5±12.9 year old.2.Puncture success rate: "Simple blind method" has 364 successful puncture cases,with a total puncture success rate of 95.3%;among them,330 cases were successful in the first puncture,and the first puncture success rate was 86.4%;the position and angle of the puncture needle were adjusted again afterwards The puncture was successful in 34 cases,and the success rate of puncture twice or more was 8.9%;18 cases(4.7%)who were unsuccessful in the “simple blind method” puncture were successfully punctured by subclavian vein.3.Complications: Among the 364 patients who used the "simple blind method" puncture,3 patients(0.82%)mistakenly penetrated the artery and healed after compression to stop the bleeding;2 patients(0.55%)developed pneumothorax,after closed thoracic drainage Healing;1 case(0.27%)developed a capsular hematoma due to preoperative use of anticoagulant drugs,and healed after 2 weeks after operation with syringe suction;postoperative follow-up found that 4 cases(1.1%)were found within 2 weeks after operation Electrode dislocation(including microdislocation)occurred,and pacemaker electrode replacement was performed on an elective basis.Among the 18 patients who were changed to the subclavian vein route,1 patient(5.56%)developed pneumothorax,which healed after closed drainage through the chest cavity;1 patient(5.56%)experienced electrode micro-dropping,and electively reset the pacemaker electrode again Surgery.4.In the patients with ultrasound positioning in this study,the actual distance between the puncture point and the ultrasound positioning point during the operation was 0.643±3.141 mm,indicating that the puncture point was within the axillary vein.5.The vertical distance between the puncture point and the clavicle(DE): The DE distance in patients undergoing "simple blind method" puncture is 4.574±0.543 cm.Among them,the DE distance in male patients was 4.598±0.536 cm,and the DE distance in female patients was 4.522±0.556 cm.There was no significant difference in the vertical distance between the puncture point and the clavicle in male patients and female patients(P>0.05).6.Pearson correlation analysis found that the vertical distance(DE)from the puncture point to the clavicle is correlated with the patient’s BMI(p<0.05).Conclusion: 1.Verified by ultrasound positioning,the "simple blind method" pre-positioned the puncture point within the axillary vein puncture range.The "simple blind method" locates the puncture point and the ultrasound locates the puncture point at approximately the same distance;2.This study found that the vertical distance between the puncture point and the clavicle(the DE segment distance)can be successfully punctured within the range of 3.5-5.5cm,and the vertical distance between the puncture point and the clavicle is correlated with the patient’s BMI;3.The "simple blind method" is simple and safe to guide axillary vein puncture,the success rate is similar to other methods,the complication rate is low,and the reproducibility is strong,which is suitable for clinical application.