Introduction
Ultrasound guided vascular access has been described for cardiac
implantable electronic device (CIED) implantation for over two decades
(1). The growing availability of ultrasound machines in cardiac
procedure labs, improvement of imaging technology including the
decreasing size of linear probe footprints, and increasing number of
published descriptions has aided this technique in becoming a highly
coveted skill amongst implanting cardiologists (2-9). Furthermore, there
is now randomized trial data demonstrating safety and efficacy in
operators who were never formally trained (10) which should encourage
more operators to attempt to adopt ultrasound guided access. This
step-by-step guide will describe a technique using both short-axis and
long-axis ultrasound views and a twisting needle cutting motion, as
opposed to the standard jabbing motion, all of which should enhance the
efficiency and safety of vascular access for all CIED implants.