How much guidewire is too much? Direct measurement of the distance from subclavian and internal jugular vein access sites to the superior vena cava-atrial junction during central venous catheter placement

Abstract

Patient height, weight, and measurements from previous chest radiographs are less reliable in predicting a safe wire length than is the access site selected. In most cases, 18 cm should be considered the upper limit of guidewire introduced during central catheter placement in adults. The guidewires supplied in catheter kits should have lengths correlated to those of the catheters, and should have distance markings printed upon them.

Complete heart block during ultrasound-guided central venous catheterization

“…Thus, physicians should be aware of such lethal however preventable complication during central venous cannulations [4], and routinely adopt measures to diagnose and reduce its risk while performing this procedure. The main ones are: continuous periprocedural ECG monitoring, and avoiding excessive insertion of guidewires, since in most cases, 18 cm should be regarded as the upper limit for introducing the guidewire during central venous catheterization in adults, and specifically for the right internal jugular vein, the mean distance to the superior vena cavaatrial junction is even shorter, with an average of 16 cm [5]. Additionally, in patients with higher risks for the development of dysrhythmias, especially if a previous left bundle branch block is detected, choosing femoral venous cannulation over the thoracic sites is an effective measure to prevent this potentially lethal complication.…”

The story of a lost guidewire

“…• As measured by Andrews et al, [5] the dis tance between skin puncture site and cavo-atrial junction via various approaches is between 16 cm and 21 cm; we advise not to insert the guidewire beyond that required length.…”

Bedside Procedure: Retained Central Venous Catheter

“…In an American based prospective study, fluoroscopy was utilized to determine this distance. It was found that the distance for right IJ insertion averaged 16 cm, right SC averaged 18.4 cm, left IJ averaged 19.1 cm, and left SC 21.2 cm [23]. A South Korean retrospective review of patients with CVC who underwent chest CT revealed slightly shorter distances.…”

“…It is imperative that the provider is aware of the guidewire length. Guidewire insertion for the placement of a CVC should never exceed 18 cm and insertion of 14 cm should be adequate for all insertion sites [23,24]. Late onset of arrhythmia is also reported with an incidence of 0.9% in indwelling tunneled or implanted port CVC [5].…”