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Difficult Internal Jugular Central Venous Cannulation Using J-Tip Guidewire with Indwelling Peripherally Inserted

Preeti Anand1, Minal Joshi1, Khaja Ahmed1

  • 1New York Presbyterian Brooklyn Methodist Hospital, USA.

Case Reports in Anesthesiology
|August 21, 2019
PubMed

Insights

Central venous catheter insertion is complicated by existing devices. A standard J-tip guidewire may worsen difficulties during internal jugular cannulation when peripherally inserted central venous catheters are present.

Area of Science:

  • Critical Care Medicine
  • Vascular Access
  • Interventional Cardiology

Background:

  • Central venous cannulation is a vital procedure for critically ill patients.
  • Increasing prevalence of indwelling devices like pacemakers and peripherally inserted central venous catheters (PICCs) complicates central venous catheter (CVC) insertion.
  • Internal jugular vein cannulation is a common CVC access site.

Observation:

  • Two cases highlight challenges during internal jugular cannulation in patients with existing PICCs.
  • The use of a standard J-tip guidewire appeared to exacerbate insertion difficulties in these cases.
  • Potential for guidewire-device interaction leading to complications was observed.

Findings:

  • Standard J-tip guidewires may increase the complexity of CVC insertion when PICCs are present.
  • Difficulties in navigating guidewires in the presence of other indwelling lines were noted.
  • The interaction between guidewires and existing devices requires careful consideration.

Implications:

  • Enhanced awareness and modified techniques are necessary for safe CVC insertion in patients with indwelling devices.
  • Guidewire selection and manipulation strategies may need adjustment to mitigate risks associated with PICCs.
  • Further investigation into optimal guidewire use in complex central venous access scenarios is warranted.

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