Development and Clinical Evaluation of a Vascular Access–Optimized Perioperative Care Pathway for Temporary Pacemaker Implantation

Background: This study aimed to evaluate the safety and feasibility of a perioperative care pathway for temporary pacemaker implantation using a median cubital vein approach. Methods: A total of 238 patients who underwent non-emergency temporary pacemaker implantation between September 2020 and October 2024 were enrolled and randomly assigned to either the femoral vein group (F group) or the median cubital vein group (M group). The M group received a standardized perioperative nursing care pathway tailored to median cubital vein access. Electrode dislodgement and procedure-related complications were compared between the groups. Patient comfort and emotional status were assessed using the General Comfort Questionnaire (GCQ), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS). The quality of nursing care was evaluated using predefined quality control standards. Results: The M group demonstrated significantly lower rates of electrode dislodgement and complications than the F group (p < 0.05). Postoperatively, GCQ scores were significantly higher in the M group, whereas SAS and SDS scores were significantly lower (all p < 0.05). Compliance with nursing care quality standards was also higher in the M group (p < 0.01). Within-group analysis showed significant reductions in SAS and SDS scores in both groups before pacemaker removal, with greater improvements observed in the M group (p < 0.05). No significant improvement in GCQ scores was observed in the F group. The M group showed also higher adherence to the standardized perioperative nursing care pathway than the F group (p < 0.01). Conclusion: Compared with femoral vein access, temporary pacemaker implantation via the median cubital vein was associated with improved safety, greater patient comfort, and better emotional outcomes. The vascular access-optimized perioperative care pathway provided meaningful clinical benefits and warrants broader implementation.