112 Randomized Comparison of Three Different Lengths of Guidewire Insertion to Reduce Arrhythmic Episodes During Central Venous Catheterization Through Right Internal Jugular Vein

Guidewire-induced asystole complicating a right internal jugular catheter placement in a patient with pre-existing left bundle branch block: A case report

“…So, it is better to consider the safe limit up to 18 cm. 3,4,10 Lee et al have a prospective study comparing the incidence of cardiac arrhythmias with three different lengths of guidewire insertion (15, 17.5, and 20 cm) during right IJV catheter insertion. Cardiac arrhythmia was reported in 26%, 35%, and 65% with 15, 17.5, and 20 cm respectively.…”

“…They reported accidental finding of significant cardiac arrhythmia in patients with severe skin toughness than those with mild or moderate skin toughness. 10 The risk factors for guidewire-induced arrhythmia are height less than 170 cm, female gender, the use of rigid guidewire, and advancing the guidewire more than 20 cm. The risk of asystole is also higher if the patient has preexisting RBBB.…”

“…The risk of asystole is also higher if the patient has preexisting RBBB. 5,10 Some authors suggest using a prophylactic temporary transvenous pacemaker in high-risk patients because of the risk of CHB, while others argue against it because of low incidence of this complication 3 and need for care during guidewire insertion in patient with pre-existing blocks.…”

“…They reported accidental finding of significant cardiac arrhythmia in patients with severe skin toughness than those with mild or moderate skin toughness. 10…”