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.