# Quantifying the Learning Curve in Ultrasound-Guided Vascular Access: Proficiency Metrics of Self-Taught Axillary Vein Puncture for CIED Implantation

## TL;DR

This study shows that self-taught ultrasound-guided axillary vein puncture for heart device implantation is safe and effective, with a high success rate.

## Contribution

The study provides real-world data on the learning curve and safety of self-taught ultrasound-guided axillary vein puncture for CIED implantation.

## Key findings

- The success rate of US-guided AVP was 94.2% with no major complications.
- Success rates improved significantly after the first six months of use.
- The technique is feasible for experienced electrophysiologists without formal training.

## Abstract

Background: Ultrasound (US)-guided axillary vein puncture (AVP) is an established technique for cardiac implantable electronic device (CIED) implantation. Yet real-world data concerning shifting from conventional venous access into US-guided AVP are not widely available. Methods: This is a single-center prospective registry reporting safety (complications) and efficacy (success rate: i.e., accomplishment of the vein access utilizing only the initially employed approach) of self-taught US-guided AVP integration into the standard workflow of CIED procedures. Results: A total of 539 patients (mean age 71.5 ± 12.4 years old, 78.7% males) were treated in our institution over a three-year period. Regarding CIED type and lead number, 58.3% used an implantable cardioverter defibrillator, 32% used permanent pacemakers, and two leads were involved in 65.8% of the cases and three leads in 8.9%. Before integration of US-guided AVP, the venous access success rate was 93.5%. The US-guided AVP success rate was 377/400 procedures (94.2%). After the first semester of US-guided AVP utilization, a pattern of increased success rate was observed (p = 0.002) and remained stable over the following semesters. No major complication (periprocedural or 30-day mortality, hemothorax, pneumothorax and tamponade) occurred after US AVP integration in our workflow. Conclusions: The integration of US-guided AVP in a self-taught manner is feasible among electrophysiologists with experience in US-guided vascular access. A high success rate can be reached quickly and safely.