Direction of the J-Tip of the Guidewire, in Seldinger Technique, Is a Significant Factor in Misplacement of Subclavian Vein Catheter: A Randomized, Controlled Study

Abstract

Misplacement of central venous catheters, predisposing to poor functioning including inability to aspirate blood, is common with the subclavian approach. In this prospective study we sought to determine whether the direction of the guidewire J-tip influenced the catheter tip placement during right subclavian catheterization. In this randomized, double-blind clinical study, we observed the placement of catheters via the right subclavian vein while keeping the J-tip directed either caudad in Group 1 (n=147) or cephalad in Group 2 (n=148) patients. The majority of catheters (97% and 57%) in Groups 1 and 2 respectively entered the superior vena cava/right atrium (P <0.05). The incidence of catheter misplacement into the ipsilateral internal jugular vein was 2% and 40% in Groups 1 and 2, respectively (P = <0.01). Subsequent experimental study confirmed that the direction of the J-tip was retained inside a model of vascular tubes and its tip led the guidewire into the tubing on the same side even at the acute angulation formed between tubings representing the subclavian, internal jugular, and superior vena cava junction complex. The authors conclude that the simple measure of keeping the guidewire J-tip directed caudad increased correct placement of central venous catheters towards the right atrium during right subclavian catheterization.

A Study on Ultrasound Assisted Cannulation of the Internal Jugular Vein in Comparison to the High Approach External Landmark Guided Technique

“…Central venous catheter tip placement at the junction of superior vena cava and right atrium is important for accurate central venous pressure measurement. 13 In our study, 5.7% malposition seen with landmark technique and none with ultrasound guided technique (p=0.00001). In a randomized controlled study authors suggest that keeping the guidewire J tip directed medially in right internal jugular vein catheterization increase correct placement of central venous cannulation towards atrium.…”

A Study of Malposition of Central Venous Catheter – A Comparative Study between Ultrasound Guided and Anatomical Landmark Technique

“…This was followed by catheter passing from one subclavian vein to the contralateral subclavian vein and vice versa (27.8%). The possible reason for these malposi ons could be the change in the direc on of the J p of the guide 11 wire during the procedure. The malposi on can be minimized by constantly keeping the J p of the guide wire in a caudal direc on.…”

A Unique Case of Accidental Ipsilateral Retrograde Internal Juglar Vein Cannulation

“…[3] [4] Studies claim that the incidence of malposition of CVCs during IJV cannulation is around 2%. [5] There are very few reports of accidental retrograde ipsilateral IJV cannulation in the past.…”