Abstract
BACKGROUND: Venous puncture failure during cardiac implantable electronic device (CIED) implantation is a significant procedural challenge, particularly in fasting patients. Pre-procedural intravenous normal saline (NS) infusion may enhance venous filling and improve procedural outcomes, but evidence in this setting is limited. METHODS: We conducted a retrospective cohort study at Abbas Institute of Medical Sciences, including 2852 patients undergoing CIED implantation. Patients were divided into two groups: those who received intravenous NS infusion prior to the procedure (n = 1130) and those who did not (n = 1722). Baseline demographics, procedural details, and outcomes-including venous puncture failure, arterial puncture, site change, and acute kidney injury (AKI)-were compared. RESULTS: The NS group demonstrated a significantly lower rate of venous puncture failure (4.6% vs. 8.9%, p < 0.001) and arterial puncture failure (1.6% vs. 2.8%, p = 0.03). AKI occurred less frequently in the NS group, although this difference was not statistically significant (1.8% vs. 2.6%, p = 0.09). Predictors of venous puncture failure included absence of NS infusion (OR 2.1, 95% CI 1.5-3.0), BMI ≥ 30, and CKD. ROC analysis demonstrated good model discrimination (AUC = 0.81). CONCLUSION: Pre-procedural NS infusion significantly improves venous puncture success in fasting patients undergoing CIED implantation.