Equipment
A standard linear array ultrasound probe (5-15 mHz) from any manufacture
provides the adequate imaging fidelity needed to perform ultrasound
guided vascular access. A long sterile ultrasound probe cover will be
needed to ensure sterility in the surgical field. Either standard
18-gauge or 21-gauge needles can be used, but echogenic needles can be
found for both gauges for various manufacturers. The latter are highly
recommended to enhance the visibility of the tip of the needle and
increase the safety of access. Standard length J-wires should be
available for insertion for each planned venous stick. The rest of the
standard equipment needed for a CIED implant should be set up as usual
including scalpels, electrocautery, and x-ray equipment. An intravenous
(IV) line should be placed preoperatively in the arm on the side of
intended access in case saline or contrast is needed to aid in axillary
vein visualization.