IMPLANTATION
18
4. Press a thumb against the index finger and project one or two
centimeters below the clavicle to shield the subclavius muscle from the
needle (when hypertrophy of the pectoralis muscle is apparent, the
thumb should project about two centimeters below the clavicle because
the subclavius muscle should be hypertrophied as well) (Figure 10).
5. Feel with the thumb the pressure from the passage of the needle
through the superficial fascia; direct the needle deep into the tissues
toward the subclavian vein and the underlying first rib. Fluoroscopic
guidance will reduce the chance that the needle would pass below the
first rib and into the lung.
Positioning the Lead
Under fluoroscopy and with the
helix retracted and a stylet in the
lead, advance the lead as far as
possible so the tip electrode is in
the apex of the right ventricle
(Figure 11 and Figure 12). Also
verify under fluoroscopy that the
distal coil electrode is situated in the
right ventricle, below the tricuspid
valve, and that the proximal coil
electrode (ENDOTAK RELIANCE
and ENDOTAK RELIANCE G lead
models only) is situated in the
superior vena cava and high right
atrium.
Correct functioning of the
lead depends on appropriate
placement of the electrodes.
Figure 10. Location of thumb and needle entry.
St
V
Cp
Figure 11. Suggested electrode
position within the heart for
ENDOTAK RELIANCE and
ENDOTAK RELIANCE G leads.
Proximal coil
electrode
Distal coil
electrode
358988-001 EN Europe.book Page 18 Monday, November 24, 2014 11:17 AM
