Influence of orientations of guidewire tip on the placement of subclavian venous catheters

Park, Hee Pyoung; Jeon, Young-Tae; Jw, Hwang; Han, Seung-Beom; Bahk, Jae Hyon; Ys, Oh

doi:10.1111/j.1399-6576.2005.00758.x

Cited by 16 publications

(9 citation statements)

References 16 publications

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“…Failure to thread the guidewire can occur when the J-tip is directed cephalad [5]. If the guidewire met any stiff resistance while advancing into the SCV, we did not advance the guidewire.…”

Section: Discussionmentioning

confidence: 99%

“…Various techniques have been suggested to avoid aberrant location of a catheter [1-5]. The direction of the guidewire J-tip is associated with misplacement of a central venous catheter and higher rate of misplacement is reported when guidewire J-tip is directed cephalad [4,5]. Although initial direction of J-tip is important on the determination of ultimate location, rotation could occur inside veins.…”

Section: Introductionmentioning

confidence: 99%

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The influence of the direction of J-tip on the placement of a subclavian catheter: real time ultrasound-guided cannulation versus landmark method, a randomized controlled trial

Jeon

Choi

et al. 2014

BMC Anesthesiol

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BackgroundIt has been reported that the direction of the guidewire J-tip is associated with misplacement of a central venous catheter. We hypothesized that real-time ultrasound-guided infraclavicular subclavian venous cannulation would be less influenced by the direction of guidewire J-tip compared to landmark method.MethodsSixty adult patients who required subclavian venous catheterization for neurosurgery were enrolled in this prospective randomized controlled study. Patients were randomly divided into a landmark group (n = 30) or an ultrasound group (n = 30). After the subclavian vein was punctured, the guidewire was advanced with the guidewire J-tip directed cephalad. Misplacement or advancement failure of the guidewire was regarded as an unsuccessful placement. Postoperative chest radiography was performed to confirm pneumothorax and the location of the catheter tip.ResultsThe two groups were comparable with respect to age, gender, height, and weight distribution. The incidence of unsuccessful guidewire placement was lower in the ultrasound group than in the landmark group (13% vs. 47%, P = 0.01). Among the unsuccessful guidewire placements, the incidence of misplacement were comparable between the groups and were all located in the ipsilateral internal jugular vein (7% vs. 7%). However, the incidence of advancement failure was significantly higher in landmark group (40% vs. 7%, P = 0.005). There were no complications such as pneumothorax or hemothorax.ConclusionsThe proper placement of guidewire was less influenced by the direction of the guidewire J-tip with ultrasound-guided subclavian venous cannulation than with the landmark approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The influence of the direction of J-tip on the placement of a subclavian catheter: real time ultrasound-guided cannulation versus landmark method, a randomized controlled trial

Jeon

Choi

et al. 2014

BMC Anesthesiol

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“…Some studies have shown that upon needle insertion, the bevel orientation facilitates the progression of the guide wire in the intended direction. 7 For example, when one attempts an internal jugular vein catheterization, orienting the needle bevel medially facilitates guide wire passage into the SVC. 8 With the same rationale, there have been small randomized controlled studies demonstrating an effect of bevel orientation in subclavian catheterizations, with a higher rate of correct placements when the bevel was oriented caudally.…”

Section: Mechanisms Of Cvc Malpositioningmentioning

confidence: 99%

Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction

Roldan¹,

Paniagua²

2015

WestJEM

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Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for “Central line malposition” and then for “Central venous catheters intravascular malposition,” we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient’s body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

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“…Currently, the tip of guidewires has a wide variety of configurations, including the three-sided (arrowhead), taper, four-sided (diamond), blunt taper, ball, lancet tip points [1], J-tipped [2], bevel-tipped [3], etc. The tip of guidewire is designed and manufactured to a configuration for a specific procedural need [1,4,5].…”

Section: Introductionmentioning

confidence: 99%

Grinding the sharp tip in thin NiTi and stainless steel wires

Wang

Tai

Loon

et al. 2012

International Journal of Machine Tools and Manufacture

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Influence of orientations of guidewire tip on the placement of subclavian venous catheters

Abstract: These data suggest that the orientation of the J-wire tip downward can increase successful placement rates of right subclavian venous catheterization.

Cited by 16 publications

References 16 publications

The influence of the direction of J-tip on the placement of a subclavian catheter: real time ultrasound-guided cannulation versus landmark method, a randomized controlled trial

The influence of the direction of J-tip on the placement of a subclavian catheter: real time ultrasound-guided cannulation versus landmark method, a randomized controlled trial

Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction

Grinding the sharp tip in thin NiTi and stainless steel wires

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