11. Lab personnel
2 Cardiologists
โ First operator (should have performed 70 implants)
โ Assistant
2 Nurses
โ Scrub nurse
โ Monotoring nurse
Cathlab technologist
Anesthetist on- call
12. Pre-implant protocol
Thorough evaluation of the patient
โ medical records esp. anticoagulants, antiplatelets
โ previous reactions to drugs and contrast
โ basic laboratory tests (coag.parameters, Xray,Echo)
Indication for pacing should be clear
Type of pacing system โ single / dual
Informed consent
Food is withheld for 6 to 8 hours
Intravenous line โ Hydration
Heparin stopped 6 hrs
Antiplatelets stopped 5 days
International Normalized Ratio (INR)<1.2
Antibiotic prophylaxis is controversial
Mild pre-procedural sedation
Prepare nipple line to the angle of the jaw bilaterally
13. Approaches
The Subclavian Method
โ Seldinger approach to the subclavian vein
โ Most popular method
โ Subclavian โstickโ using an 18-G needle
โ 2 separate subclavian punctures when
placing a dual chamber pacing
Axillary Vein Approach
Cephalic Vein Approach
โ almost no risk of pneumothorax or
hemothorax