Boston Scientific EASYTRAK 2 IS-1, Руководство врача-руководителя

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IMPLANTATION—EASYTRAK 2 IS-1 LEAD
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Scientific recommends introducing the lead into the subclavian vein near
the lateral border of the first rib.
The syringe should be positioned directly above and parallel to the axillary
vein to reduce the chance that the needle will contact the axillary or
subclavian arteries or the brachial plexus. Use of fluoroscopy is helpful in
locating the first rib and in guiding the needle. The steps below explain how
to identify the skin entry point and define the course of the needle toward
the subclavian vein where it crosses the first rib.
1. Referring to Figure 2, identify points St (sternal angle) and Cp (coracoid
process).
2. Visually draw a line between St and Cp, and divide the segment into
thirds. The needle should pierce the skin at the junction of the middle
and lateral thirds, directly above the axillary vein (point Ax).
3. Place an index finger on the clavicle at the junction of the medial and
middle thirds (point V), beneath which point the subclavian vein should
be located.
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 3).
Figure 2. Landmarks identify the entry point for
a percutaneous subclavian venipuncture.
Subclavius muscle
Costocoracoid lig.
Costoclavicular lig.
Cp
V
M
St
Ax
356995-051 EN Europe.book Page 11 Monday, August 8, 2011 3:43 PM