Ultrasound confirmation of guidewire position may eliminate accidental arterial dilatation during central venous cannulation

Abstract

BackgroundUltrasound guidance during central line insertion has significantly reduced complications associated with this procedure and has led to it being incorporated as standard of care in many institutions. However, inadvertent arterial penetration and dilation remains a problem despite ultrasound guidance and can result in significant morbidity and even mortality. Dynamic ultrasound confirmation of guidewire position within the vein prior to dilation may help to prevent and even eliminate this feared complication.MethodsA prospectively collected database of central line insertions for one author utilizing this novel technique was retrospectively reviewed for all incidents of arterial dilation over a period from September 2008 to January 2010.ResultsDuring the study period 53 central lines were inserted with no incidents of arterial dilation.ConclusionsUltrasound confirmation of guidewire position has the potential to reduce or eliminate the morbidity and mortality of arterial dilation during central line placement.

Eventos adversos hospitalarios en medicina interna: estudio prospectivo

“…Pueden generarse problemas inmediatos tras su colocación como sangrado, punción arterial, arritmias y neumotórax (estas dos últimas no se producen en las de implantación femoral); o tardías como infección, trombosis venosa, migración o embolización del catéter 122 .…”

“…Actualmente se está preconizando, en casos seleccionados, la canalización de una vía central con acceso periférico y el uso de la ecografía, sobre todo para la cateterización de la vena subclavia, con evidencia en la disminución de complicaciones (fracaso en la canalización, punción arterial, hematoma y neumotórax) 122 . Por otra parte no se recomienda su reemplazo de rutina 125 .…”

The wire is really easy to see (WIRES): sonographic visualization of the guidewire by novices

“…9,10 A retrospective review of central line insertions by a single experienced operator using this technique revealed no inadvertent arterial cannulations. 11 The reliability of this technique, however, has not yet been demonstrated among practitioners with less extensive training. In this study, we hypothesized that with minimal training, medical students and residents would be able to determine guidewire location in an inanimate model with a high degree of accuracy.…”

“…[5][6][7][8] One proposed method for avoiding carotid artery cannulation is to visualize the guidewire sonographically ( Figure 1) prior to dilation and placement of the catheter. [9][10][11] Previous studies have demonstrated that the guidewire is easier to visualize than the needle and that physicians with fellowship training in ultrasonography can determine guidewire positioning with 100% accuracy. 9,10 A retrospective review of central line insertions by a single experienced operator using this technique revealed no inadvertent arterial cannulations.…”

“…Nonetheless, we maintain that wire visualization has the potential to improve safety. [9][10][11] Anecdotally, one of the participants in this study has since reported avoidance of carotid artery cannulation due to recognition of an improperly placed wire.…”