| Objective: Intervention within the heart intervention operation, such ascardiac electrophysiological study, radiofrequency catheter ablation andpacemaker implantation, etc. have been shown to be safe effective methods ofdiagnosis and treatment of various arrhythmias and has been widely used inclinical. However, the success of the vessel puncture is the basic steps, and thesubclavian vein is the most common vascular pathways in the abovementioned operation. Therefore, for the whole operation, the basic and key isthe fast, safe and successful puncture in the subclavian vein. The purpose ofthis research is to study the imaging data of the patients who were successfullypunctured and research how to improve the success rate of the subclavian veinpuncture.Subjects: The number of patients selected a total of64cases, those whoin August2011to November2011at the Second Hospital of Hebei MedicalUniversity with paroxysmal supraventricular tachycardia, ventriculartachycardia,atrial fibrillation for radiofrequency catheter ablation (RFCA) andsick sinus syndrome,atrioventricular block for pacemaker implantation, aged15to85years,40males and24females. For RFCA of53cases,11cases ofpacemaker implantation.Methods: The puncture site was at1cm below the middle point of theclavicle. The needle, directing towards the sternum incisure and keeping closeto the clavicular posterior border, punctured into the subclavian vein. Theneedle is parallel with chest or have a angle between5°to10°. If puncture isnot successful, then edge of the junction of the first costal cartilage and theclavicle parallel to outward3cm at the given point along the subclavian, thuspoints upward triangular in shape with the clavicle, the needle puncture intoin this triangle, the needle should be pointed toward inside and behind of theclavicle. The cases were successfully punctured through the X-ray, we observed the form of the clavicle and the first costal cartilage, and used theMed Explorer DICOM image processing software to measure the anglebetween the clavicle and the horizontal, the angle between the clavicle and thefirst costal cartilage, the angle between the needle and the clavicle, the anglebetween the needle and the first costal cartilage, the distance between theneedle point and spine edge.Statistical analysis: Creating a database through the application of SPSS18.0software package for statistical analysis. The measurement data wereexpressed as mean±standard deviation (x±s), and the count data wereexpressed as a percentage. Clavicle form comparison, according to the patientsof different gender, using independent samples t-test, the situation of dualvariables used linear correlation, and the data to x±s. P＜0.05was consideredstatistically significant.Results: The average age was50.46±17.06years old (15～85years old)in64cases,40males (62.50%) and24females(37.5%). The number ofpatients with those implementation of RFCA was53cases (82.81%), thosewho were punctured in the left subclavian vein. The number of patients wasmade pacemaker implantation is11cases(17.19%), those who were puncturedin the right subclavian vein. The overall success rate was100%. The resultsshowd that the angle between the clavicle and the horizontal line was31.55±5.74°on average, of which less than30°was a total of25cases(39.06%),30°~45°a total of39cases (60.94%). The comparison of angle hada significant difference between left and right (30.71±5.34°vs35.56±6.15°, P＜0.05). The angle between the puncture needle and the clavicle was36.74±9.79°on average. The comparison of angle had a significant differencebetween left and right(37.13±7.86°vs34.90±16.66°, P＜0.05). Thecomparison of angle had a significant difference between male and female(39.06±8.97°vs32.89±10.06°, P＜0.05). There were a rectilinear correlationbetween the angle of the clavicle and the horizontal line and the angle of theneedle and the clavicle(r＝0.349, P＜0.05). The angle of the clavicle and thefirst costal cartilage was92.72±19.12°on the average. The angle of the needle and the first costal cartilage was92.81±18.25°on the average. The distancebetween the needle and the vertebral column was1.74±0.56vertebral height atan average level. Among them, gender was no significant difference betweenthe angle of the clavicle and the horizontal, the angle between the clavicle andthe first costal cartilage, the angle between the needle and the first costalcartilage, the distance between the needle point and spine edge (P＜0.05).Conclusion: In this study, through the analysis of X-ray imaging datain successful subclavian venipuncture, we found that the clavicle's shape isdifferent,39.06%in patients with subclavian is taken shape straight, and60.94%is out of shape bend. And the majority of patients with subclavian veinpuncture point is fixed, while a small number of patients isn't fixed, whichis related to the clavicle course. There were10.25%of patients whose clavicletraveling upturned that subclavian vein located below and behind the clavicle,and4%of patients whose clavicle traveling straight that subclavian veinlocated posterosuperior of the clavicle. In this way, applying the angulationbetween clavicle and the horizontal line to subclavian vein puncture canimprove the success rate of subclavian vein puncture and reduce thecomplication incidences. The comparison of angle between the clavicleand the horizontal line had a significant difference between left and right. Thecomparison of angle between the clavicle and the needle had a significantdifference between left and right, and also between the gender. |
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