Boston Scientific EASYTRAK 2 IS-1, Physician'S Lead Manual

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EASYTRAK 2 IS-1 LEAD—IMPLANTATION
10
IMPLANTATION
Inserting the Lead
The lead may be inserted using one of the following two methods:
Via cutdown through the left or right cephalic vein.
Only one incision over the deltopectoral groove is required to insert the
guiding catheter through the cephalic vein. The endocardial lead is inserted
into the right or left cephalic vein in the deltopectoral groove.
The vein pick packaged with this lead can be used during a cutdown
procedure to aid insertion of the guiding catheter into the vein. Before
inserting the guiding catheter, see the section, “Lead Accessories” for
instructions on using the vein pick.
Percutaneously or via cutdown through the subclavian vein or internal
jugular vein—typically the left subclavian or right internal jugular vein.
A subclavian introducer set is available from Boston Scientific for use during
percutaneous lead insertion.
CAUTION: When attempting to implant the lead via a subclavian puncture,
do not insert the lead under the medial one-third region of the clavicle.
Damage or chronic dislodgment to the lead is possible if the lead is
implanted in this manner. If implantation via the subclavian vein is
desired, the lead must enter the subclavian vein near the lateral border
of the first rib and must avoid penetrating the subclavius muscle. It is
important to observe these implant precautions to avoid clavicle/first rib
damage or chronic dislodgment to the lead. It has been established in
the literature that lead fracture can be caused by lead entrapment in
such soft tissue structures as the subclavius muscle, costocoracoid
ligament, or the costoclavicular ligament.
2
Leads placed by percutaneous subclavian venipuncture should enter the
subclavian vein, where it passes over the first rib (rather than more
medially), to avoid entrapment by the subclavius muscle or ligamentous
structures associated with the narrow costoclavicular region.
3
Boston
2. Magney JE, et al. Anatomical mechanisms explaining damage to pacemaker leads,
defibrillator leads, and failure of central venous catheters adjacent to the sternoclavicular
joint. PACE. 1993;16:445-457.
3. Magney JE, et al. A new approach to percutaneous subclavian venipuncture to avoid lead
fracture or central venous catheter occlusion. PACE. 1993;16:2133-2142.
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