Body mass index is related to unsuccessful puncture attempts and failure to axillary vein cannulation during ultrasound-guided cardiac electronic device implantation
Purpose Ultrasound (US)-guided axillary vein cannulation is effective and safe during cardiac implantable electronic devices (CIEDs). It is a reasonable alternative to other techniques in order to shorten procedural time and decrease perioperative complications. However, in this context, the short-a...
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| Veröffentlicht in: | Journal of interventional cardiac electrophysiology 2021-08, Vol.61 (2), p.253-259 |
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| creator | De Sensi, Francesco Addonisio, Luigi Baratta, Pasquale Breschi, Marco Cresti, Alberto Miracapillo, Gennaro Limbruno, Ugo |
| description | Purpose
Ultrasound (US)-guided axillary vein cannulation is effective and safe during cardiac implantable electronic devices (CIEDs). It is a reasonable alternative to other techniques in order to shorten procedural time and decrease perioperative complications. However, in this context, the short-axis (out-of-plane) visualization to guide the vein puncture is the most used technique. The aim of our study is to describe a single-center experience with the US long-axis (in-plane) technique defining predictors of unsuccessful puncture attempts and failure to axillary vein cannulation in a cohort of patients undergoing CIEDs procedures.
Methods
From November 2017 to June 2019, consecutive patients undergoing CIEDs procedures were enrolled in the study. US-guided long axis (in-plane) view to guide axillary vein cannulation was used in all subjects. Unsuccessful puncture attempts (UAs) and complete failures to cannulate the vein were collected for each procedure. All patients were evaluated on a daily basis until hospital discharge and at 1-month follow up visit.
Results
Among 119 subjects (M: F = 75:44), mean age was 79 ± 9 years, mean BMI 25.7 ± 4.3 kg/m
2
, and mean BSA 1.74 ± 0.4 m
2
. We placed 95 pacemakers (32 single-, 61 dual-, and 2 triple-chamber) and 20 ICDs (7 single, 6 dual, 7 triple chambers). An upgrade from dual-chamber to triple-chamber device was carried out with the addition of a new lead in 3 patients. During a system revision, one new electrode was implanted. The overall leads inserted were 204. There were 33 initial unsuccessful attempts in 22/119 patients. US-guided axillary access was finally successful in 94.9% of patients (113/119). In the other cases (6/119), cephalic vein was isolated or blinded subclavian puncture was performed. Interestingly, at univariate analysis, an increasing BMI and BSA, male sex, and anticoagulant therapy were predictors of unsuccessful attempts or failure to cannulate the vein with US. Among those subjects, the multivariate logistic regression showed significant correlations only between BMI and unsuccessful attempts: odds ratio (OR) = 1.16,
p
= 0.009 [95% CI = 1.04–1.31], and BMI with failure to cannulate the vein: OR = 1.21,
p
= 0.03 [95%CI = 1.01–1.45]. The receiver operating characteristic (ROC) curves individuated the best BMI value cutoff point at 27 kg/m
2
(area under the curve [AUC]: 68.6%) having a sensitivity of 63.6% and a specificity of 66.5% for unsuccessful puncture attempts; a BMI value of 2 |
| doi_str_mv | 10.1007/s10840-020-00800-3 |
| format | Article |
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Ultrasound (US)-guided axillary vein cannulation is effective and safe during cardiac implantable electronic devices (CIEDs). It is a reasonable alternative to other techniques in order to shorten procedural time and decrease perioperative complications. However, in this context, the short-axis (out-of-plane) visualization to guide the vein puncture is the most used technique. The aim of our study is to describe a single-center experience with the US long-axis (in-plane) technique defining predictors of unsuccessful puncture attempts and failure to axillary vein cannulation in a cohort of patients undergoing CIEDs procedures.
Methods
From November 2017 to June 2019, consecutive patients undergoing CIEDs procedures were enrolled in the study. US-guided long axis (in-plane) view to guide axillary vein cannulation was used in all subjects. Unsuccessful puncture attempts (UAs) and complete failures to cannulate the vein were collected for each procedure. All patients were evaluated on a daily basis until hospital discharge and at 1-month follow up visit.
Results
Among 119 subjects (M: F = 75:44), mean age was 79 ± 9 years, mean BMI 25.7 ± 4.3 kg/m
2
, and mean BSA 1.74 ± 0.4 m
2
. We placed 95 pacemakers (32 single-, 61 dual-, and 2 triple-chamber) and 20 ICDs (7 single, 6 dual, 7 triple chambers). An upgrade from dual-chamber to triple-chamber device was carried out with the addition of a new lead in 3 patients. During a system revision, one new electrode was implanted. The overall leads inserted were 204. There were 33 initial unsuccessful attempts in 22/119 patients. US-guided axillary access was finally successful in 94.9% of patients (113/119). In the other cases (6/119), cephalic vein was isolated or blinded subclavian puncture was performed. Interestingly, at univariate analysis, an increasing BMI and BSA, male sex, and anticoagulant therapy were predictors of unsuccessful attempts or failure to cannulate the vein with US. Among those subjects, the multivariate logistic regression showed significant correlations only between BMI and unsuccessful attempts: odds ratio (OR) = 1.16,
p
= 0.009 [95% CI = 1.04–1.31], and BMI with failure to cannulate the vein: OR = 1.21,
p
= 0.03 [95%CI = 1.01–1.45]. The receiver operating characteristic (ROC) curves individuated the best BMI value cutoff point at 27 kg/m
2
(area under the curve [AUC]: 68.6%) having a sensitivity of 63.6% and a specificity of 66.5% for unsuccessful puncture attempts; a BMI value of 28 kg/m
2
(AUC 74.9%) had a sensitivity of 66.7% and a specificity of 66.7% for failure to cannulate the vein with the US-guided approach.
Conclusions
Axillary vein long-axis (in-plane) US-guided cannulation during CIEDs implantation is characterized by a high success rate (94.9%). An elevated BMI is significantly related to unsuccessful puncture attempts or failure to cannulation. The higher is the BMI, the more are the chances to have difficult vein puncture or cannulation failure and to switch from US-guided approach to another technique.</description><identifier>ISSN: 1383-875X</identifier><identifier>EISSN: 1572-8595</identifier><identifier>DOI: 10.1007/s10840-020-00800-3</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Body mass ; Body mass index ; Body size ; Cannulation ; Cardiology ; Chambers ; Complications ; Electronic devices ; Electronic equipment ; Failure ; Heart ; Implantation ; Medicine ; Medicine & Public Health ; Pacemakers ; Patients ; Sensitivity ; Ultrasonic imaging ; Ultrasound</subject><ispartof>Journal of interventional cardiac electrophysiology, 2021-08, Vol.61 (2), p.253-259</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-952eb0a5a6bd7e43b1e7569d3a57c8444a3ba1baa69dc854218cfb3f06892d9d3</citedby><cites>FETCH-LOGICAL-c352t-952eb0a5a6bd7e43b1e7569d3a57c8444a3ba1baa69dc854218cfb3f06892d9d3</cites><orcidid>0000-0002-9742-7101</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10840-020-00800-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10840-020-00800-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids></links><search><creatorcontrib>De Sensi, Francesco</creatorcontrib><creatorcontrib>Addonisio, Luigi</creatorcontrib><creatorcontrib>Baratta, Pasquale</creatorcontrib><creatorcontrib>Breschi, Marco</creatorcontrib><creatorcontrib>Cresti, Alberto</creatorcontrib><creatorcontrib>Miracapillo, Gennaro</creatorcontrib><creatorcontrib>Limbruno, Ugo</creatorcontrib><title>Body mass index is related to unsuccessful puncture attempts and failure to axillary vein cannulation during ultrasound-guided cardiac electronic device implantation</title><title>Journal of interventional cardiac electrophysiology</title><addtitle>J Interv Card Electrophysiol</addtitle><description>Purpose
Ultrasound (US)-guided axillary vein cannulation is effective and safe during cardiac implantable electronic devices (CIEDs). It is a reasonable alternative to other techniques in order to shorten procedural time and decrease perioperative complications. However, in this context, the short-axis (out-of-plane) visualization to guide the vein puncture is the most used technique. The aim of our study is to describe a single-center experience with the US long-axis (in-plane) technique defining predictors of unsuccessful puncture attempts and failure to axillary vein cannulation in a cohort of patients undergoing CIEDs procedures.
Methods
From November 2017 to June 2019, consecutive patients undergoing CIEDs procedures were enrolled in the study. US-guided long axis (in-plane) view to guide axillary vein cannulation was used in all subjects. Unsuccessful puncture attempts (UAs) and complete failures to cannulate the vein were collected for each procedure. All patients were evaluated on a daily basis until hospital discharge and at 1-month follow up visit.
Results
Among 119 subjects (M: F = 75:44), mean age was 79 ± 9 years, mean BMI 25.7 ± 4.3 kg/m
2
, and mean BSA 1.74 ± 0.4 m
2
. We placed 95 pacemakers (32 single-, 61 dual-, and 2 triple-chamber) and 20 ICDs (7 single, 6 dual, 7 triple chambers). An upgrade from dual-chamber to triple-chamber device was carried out with the addition of a new lead in 3 patients. During a system revision, one new electrode was implanted. The overall leads inserted were 204. There were 33 initial unsuccessful attempts in 22/119 patients. US-guided axillary access was finally successful in 94.9% of patients (113/119). In the other cases (6/119), cephalic vein was isolated or blinded subclavian puncture was performed. Interestingly, at univariate analysis, an increasing BMI and BSA, male sex, and anticoagulant therapy were predictors of unsuccessful attempts or failure to cannulate the vein with US. Among those subjects, the multivariate logistic regression showed significant correlations only between BMI and unsuccessful attempts: odds ratio (OR) = 1.16,
p
= 0.009 [95% CI = 1.04–1.31], and BMI with failure to cannulate the vein: OR = 1.21,
p
= 0.03 [95%CI = 1.01–1.45]. The receiver operating characteristic (ROC) curves individuated the best BMI value cutoff point at 27 kg/m
2
(area under the curve [AUC]: 68.6%) having a sensitivity of 63.6% and a specificity of 66.5% for unsuccessful puncture attempts; a BMI value of 28 kg/m
2
(AUC 74.9%) had a sensitivity of 66.7% and a specificity of 66.7% for failure to cannulate the vein with the US-guided approach.
Conclusions
Axillary vein long-axis (in-plane) US-guided cannulation during CIEDs implantation is characterized by a high success rate (94.9%). An elevated BMI is significantly related to unsuccessful puncture attempts or failure to cannulation. The higher is the BMI, the more are the chances to have difficult vein puncture or cannulation failure and to switch from US-guided approach to another technique.</description><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Cannulation</subject><subject>Cardiology</subject><subject>Chambers</subject><subject>Complications</subject><subject>Electronic devices</subject><subject>Electronic equipment</subject><subject>Failure</subject><subject>Heart</subject><subject>Implantation</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Pacemakers</subject><subject>Patients</subject><subject>Sensitivity</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><issn>1383-875X</issn><issn>1572-8595</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kctq3jAQhU1poWmaF8hK0E03bnS15WUbeoNANw10J8bSOCjYkqtLSB4o71n9-QuFLrIYNAzfOZLmdN05ox8YpeNFZlRL2lPeimpKe_GiO2Fq5L1Wk3rZeqFFr0f163X3JudbSulE-XDSPX6K7oFskDPxweE98ZkkXKGgIyWSGnK1FnNe6kr2GmypCQmUgtteMoHgyAJ-PQwbDfd-XSE9kDv0gVgIoTYnHwNxNflwQ-paEuRYg-tvqnftDgvJebAEV7QlxeAtcXjnLRK_7SuE8qR_271aYM149vc87a6_fP55-a2_-vH1--XHq94KxUs_KY4zBQXD7EaUYmY4qmFyAtRotZQSxAxsBmgzq5XkTNtlFgsd9MRd406790ffPcXfFXMxm88W26cCxpoNl2zgI9daNvTdf-htrCm01xmu1KCknEbdKH6kbIo5J1zMnvzWVmQYNYfkzDE505IzT8kZ0UTiKMr7YWuY_lk_o_oDV1mgiA</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>De Sensi, Francesco</creator><creator>Addonisio, Luigi</creator><creator>Baratta, Pasquale</creator><creator>Breschi, Marco</creator><creator>Cresti, Alberto</creator><creator>Miracapillo, Gennaro</creator><creator>Limbruno, Ugo</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9742-7101</orcidid></search><sort><creationdate>20210801</creationdate><title>Body mass index is related to unsuccessful puncture attempts and failure to axillary vein cannulation during ultrasound-guided cardiac electronic device implantation</title><author>De Sensi, Francesco ; Addonisio, Luigi ; Baratta, Pasquale ; Breschi, Marco ; Cresti, Alberto ; Miracapillo, Gennaro ; Limbruno, Ugo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-952eb0a5a6bd7e43b1e7569d3a57c8444a3ba1baa69dc854218cfb3f06892d9d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Cannulation</topic><topic>Cardiology</topic><topic>Chambers</topic><topic>Complications</topic><topic>Electronic devices</topic><topic>Electronic equipment</topic><topic>Failure</topic><topic>Heart</topic><topic>Implantation</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Pacemakers</topic><topic>Patients</topic><topic>Sensitivity</topic><topic>Ultrasonic imaging</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>De Sensi, Francesco</creatorcontrib><creatorcontrib>Addonisio, Luigi</creatorcontrib><creatorcontrib>Baratta, Pasquale</creatorcontrib><creatorcontrib>Breschi, Marco</creatorcontrib><creatorcontrib>Cresti, Alberto</creatorcontrib><creatorcontrib>Miracapillo, Gennaro</creatorcontrib><creatorcontrib>Limbruno, Ugo</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of interventional cardiac electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>De Sensi, Francesco</au><au>Addonisio, Luigi</au><au>Baratta, Pasquale</au><au>Breschi, Marco</au><au>Cresti, Alberto</au><au>Miracapillo, Gennaro</au><au>Limbruno, Ugo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Body mass index is related to unsuccessful puncture attempts and failure to axillary vein cannulation during ultrasound-guided cardiac electronic device implantation</atitle><jtitle>Journal of interventional cardiac electrophysiology</jtitle><stitle>J Interv Card Electrophysiol</stitle><date>2021-08-01</date><risdate>2021</risdate><volume>61</volume><issue>2</issue><spage>253</spage><epage>259</epage><pages>253-259</pages><issn>1383-875X</issn><eissn>1572-8595</eissn><abstract>Purpose
Ultrasound (US)-guided axillary vein cannulation is effective and safe during cardiac implantable electronic devices (CIEDs). It is a reasonable alternative to other techniques in order to shorten procedural time and decrease perioperative complications. However, in this context, the short-axis (out-of-plane) visualization to guide the vein puncture is the most used technique. The aim of our study is to describe a single-center experience with the US long-axis (in-plane) technique defining predictors of unsuccessful puncture attempts and failure to axillary vein cannulation in a cohort of patients undergoing CIEDs procedures.
Methods
From November 2017 to June 2019, consecutive patients undergoing CIEDs procedures were enrolled in the study. US-guided long axis (in-plane) view to guide axillary vein cannulation was used in all subjects. Unsuccessful puncture attempts (UAs) and complete failures to cannulate the vein were collected for each procedure. All patients were evaluated on a daily basis until hospital discharge and at 1-month follow up visit.
Results
Among 119 subjects (M: F = 75:44), mean age was 79 ± 9 years, mean BMI 25.7 ± 4.3 kg/m
2
, and mean BSA 1.74 ± 0.4 m
2
. We placed 95 pacemakers (32 single-, 61 dual-, and 2 triple-chamber) and 20 ICDs (7 single, 6 dual, 7 triple chambers). An upgrade from dual-chamber to triple-chamber device was carried out with the addition of a new lead in 3 patients. During a system revision, one new electrode was implanted. The overall leads inserted were 204. There were 33 initial unsuccessful attempts in 22/119 patients. US-guided axillary access was finally successful in 94.9% of patients (113/119). In the other cases (6/119), cephalic vein was isolated or blinded subclavian puncture was performed. Interestingly, at univariate analysis, an increasing BMI and BSA, male sex, and anticoagulant therapy were predictors of unsuccessful attempts or failure to cannulate the vein with US. Among those subjects, the multivariate logistic regression showed significant correlations only between BMI and unsuccessful attempts: odds ratio (OR) = 1.16,
p
= 0.009 [95% CI = 1.04–1.31], and BMI with failure to cannulate the vein: OR = 1.21,
p
= 0.03 [95%CI = 1.01–1.45]. The receiver operating characteristic (ROC) curves individuated the best BMI value cutoff point at 27 kg/m
2
(area under the curve [AUC]: 68.6%) having a sensitivity of 63.6% and a specificity of 66.5% for unsuccessful puncture attempts; a BMI value of 28 kg/m
2
(AUC 74.9%) had a sensitivity of 66.7% and a specificity of 66.7% for failure to cannulate the vein with the US-guided approach.
Conclusions
Axillary vein long-axis (in-plane) US-guided cannulation during CIEDs implantation is characterized by a high success rate (94.9%). An elevated BMI is significantly related to unsuccessful puncture attempts or failure to cannulation. The higher is the BMI, the more are the chances to have difficult vein puncture or cannulation failure and to switch from US-guided approach to another technique.</abstract><cop>New York</cop><pub>Springer US</pub><doi>10.1007/s10840-020-00800-3</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9742-7101</orcidid></addata></record> |
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| ispartof | Journal of interventional cardiac electrophysiology, 2021-08, Vol.61 (2), p.253-259 |
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| source | SpringerLink Journals |
| subjects | Body mass Body mass index Body size Cannulation Cardiology Chambers Complications Electronic devices Electronic equipment Failure Heart Implantation Medicine Medicine & Public Health Pacemakers Patients Sensitivity Ultrasonic imaging Ultrasound |
| title | Body mass index is related to unsuccessful puncture attempts and failure to axillary vein cannulation during ultrasound-guided cardiac electronic device implantation |
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