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With the increased use of transradial access (TRA) for cardiac catheterization (CC), reliable venous access for right heart cath (RHC) from the arm is necessary to allow both arterial and venous access from the arm, to minimize crossover to a femoral or jugular vein. Limited data exists on the role of real time ultrasound-guided venous access of the arm (UGVAA) for RHC.
Patients undergoing RHC at a single center by two ‘radial first’ operators who use ultrasound guidance for vascular access were identified from August 2015 to July 2016. Medical records were retrospectively reviewed.
267 consecutive RHCs were performed using 5 Fr (25.5%) and 6 Fr (74.5%) sheaths. 253 (94.8%) were performed through an arm vein, of which 3 used a pre-existing IV catheter for access. The other 250 had a 100% success rate of venous access sheath insertion in the cath lab. UGVAA was used in 241 of these 250 (96.4%) patients, and not documented, but most likely used, in 9 (3.6%) patients. RHC via the arm vein was successful in 248 (98%) patients and failed in 5 (2%) cases. Reasons for RHC failure in these 5 cases were: 1) Friction in the left subclavian vein from ICD wires; 2) Left subclavian vein thrombosis from previous ICD placement; 3) Difficulty in maneuvering the catheter; 4) Inability to advance a catheter from the right ventricle into the pulmonary artery; and 5) Kinked sheath requiring crossover to the femoral vein. The femoral approach was used in 13 (4.9%) patients, of which 11 used the femoral vein as the primary access site with concomitant radial artery access, 1 had a pre-existing femoral venous sheath, and 1 was switched to the femoral vein from unsuccessful arm attempts. The remaining 1 patient had a jugular approach to leave a triple lumen catheter in place. All patients had concomitant left heart catheterization, of which 24 (9%) patients had a simultaneous coronary interventional procedure.
UGVAA was a highly efficacious and safe method for RHC in this retrospective study, with a success rate of 98% in 253 consecutive patents. UGVAA may allow avoidance of femoral or jugular venous access in almost all patients when TRA is used and RHC is needed.
OTHER: Vascular Access