Right heart catheterization using antecubital venous access: Feasibility, safety and adoption rate in a tertiary center. Issue 1 (9th November 2013) - Shah, Sachin
Abstract : Objectives: To determine feasibility, safety, and adoption rates of right heart catheterization (RHC) using antecubital venous access (AVA) as compared to using the traditional approach of proximal venous access (PVA). Background: RHC via PVA (i.e., internal jugular, femoral or subclavian) is generally a low risk procedure; however, complications may occur and are usually access site related. RHC via an antecubital approach has regained attention given the increase in transradial left heart catheterizations. Methods: Patients undergoing RHC for any indication at a single large academic medical center were identified over a 5‐year period (January 2008 to December 2012) from a database. Medical records were retrospectively analyzed for demographic, procedural and outcomes data. Results: Two hundred seventy‐two RHC procedures were included (106 AVA, 166 PVA). The adoption rate of AVA for RHC increased rapidly since its introduction in our laboratory in 2010 (100% PVA in 2008 and 2009, 85% AVA in 2012). All procedures were successful; however, 6% of procedures required additional, alternate access to the original site. Initial success rates were similar in the two groups (91 vs. 96% for AVA and PVA respectively, P = 0.12). Fluoroscopy time was shorter in the group of patients who underwent the procedure via AVA. The complication rate was 0% in the AVA group compared with 3% in the PVA group ( P = 0.16). Conclusion: RHC via the AVA is a feasible and safe alternative to PVA. Our experience and rapid adoption support the use AVA as the access site of choice for RHC in uncomplicated patients. © 2013 Wiley Periodicals, Inc.