19
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 Lead in Right Ventricle
Correct functioning of the lead depends on appropriate placement of the
electrodes. Follow the instructions below to position the lead.
1.
Partially withdraw the stylet during lead positioning to minimize tip
stiffness.
NOTE:
A curved stylet may enhance maneuverability.
2.
Under fluoroscopy and with a stylet in the lead, advance the lead as far as
possible until the tip enters and becomes lodged in healthy myocardium in
the apex of the right ventricle.
WARNING:
Take care to obtain appropriate electrode position. Failure to do
so may result in higher defibrillation thresholds or may render the lead unable
to defibrillate a patient whose tachyarrhythmia(s) might otherwise be
convertible by a pulse generator system.
[1] Proximal coil electrode [2] Distal coil electrode
Figure 7.
Suggested electrode position within the heart
