Identification and correction of guide wire malposition during internal jugular cannulation with ultrasound

Real-time ultrasound guidance for central venous catheterization increases success and reduces procedural complications. I describe a case in which guide wire resistance was encountered and real-time ultrasound visualization of the guide wire facilitated correction of guide wire malposition. No additional passes of the introducer needle were necessary and the chances of inadvertent carotid artery puncture or pneumothorax were therefore reduced. The technique described here may prove valuable when guide wire resistance is encountered while placing a central venous catheter.