Ultrasound-guided venous puncture in electrophysiological procedures: a safe method, rapidly learned.

ABSTRACT

BACKGROUND: We sought to determine the feasibility and learning curve associated with systematic use of real-time ultrasound-guided venous puncture (UGVP) in patients undergoing electrophysiological (EP) procedures. METHODS: Four operators performed UGVP in consecutive patients undergoing EP procedures (group I). Puncture time was defined as the time from ultrasound (US) visualization of the femoral vein to the insertion of all sheaths. A learning curve as defined by UGVP evolution over the time was established for each operator. This population was compared to an historical group of patients in whom venous puncture was performed without US (group II). RESULTS: A total of 150 patients per group were included. UGVP was successfully achieved in all patients. Mean time for 2.8 ± 0.7 sheaths per patient insertion was 280 ± 151 seconds in group I. There was one minor vascular complication (VC) out of 150 patients (0.66%) without major VC in group I as compared with group II (2% major VC and 4.6% minor VC; P < 0.05). UGVP time reached a plateau at the sixth patient-case for each operator; thus, learning curve was estimated to six patients. CONCLUSION: UGVP is a short learning curve technique, significantly associated with a low incidence of minor VCs. This study supports wide use of UGVP in patients undergoing EP procedures.