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Right heart catheterization and other venous cardiovascular procedures from the arm

IC Gilchrist

Access to the central venous system and the circulation of the right heart continues to evolve with improvements in technology and the needs of medical diagnosis and therapeutics. Early cardiovascular investigators first accessed the central venous system via forearm veins to understand the physiology and pathophysiology of heart disease. With time, there derived a need to access the central venous system, not only to understand the function of the cardiopulmonary system, but also to build on the developing physiologic knowledge base and to therapeutically monitor cardiovascular hemodynamics. In addition, the ability to provide therapy directly with devices that require delivery to the central venous system, such as temporary pacing, right side endomyocardial biopsy and placement of vena cava filters, has developed. This evolution continues today, with trends to move procedural entry sites to less invasive locations such as the arm versus the central venous or femoral sites, with their inherent hazards. The purpose of this article is to highlight this evolution in central venous access with an emphasis on practical advice based on personal experience of how to assess to the right heart system and to consider trends for the future.