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The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire
Published on: December 23, 2014
Minimal guidewire length for central venous catheterization of the right subclavian vein: A CT-based consecutive case
Maria Adrian1,2, Pär Bengtsson3, Ola Borgquist2,4
1Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Sweden.
Insights
Central venous catheter (CVC) misplacement during right subclavian vein catheterization can be prevented by ensuring the guidewire remains in the lower superior vena cava. Many commercial CVC kits have guidewires that are too short, increasing the risk of misplacement.
Area of Science:
- Medical Devices
- Vascular Access
- Ultrasound Guidance
Background:
- Central venous catheter (CVC) misplacement is common with right subclavian vein catheterization.
- Ultrasound guidance can confirm correct guidewire placement, but retraction during CVC insertion can lead to malposition.
- Maintaining correct guidewire tip position is crucial for preventing CVC misplacement.
Purpose of the Study:
- To determine the minimal guidewire length needed to maintain correct tip position in the lower superior vena cava.
- To assess the adequacy of guidewire lengths in commercial CVC kits for right subclavian vein catheterization.
Main Methods:
- Computed tomography scans of 100 adult patients were analyzed.
- Vessel length from puncture site to optimal guidewire position was measured.
- Commercial 15-16 cm CVC kits were measured and compared to patient anatomy.
Main Results:
- The 95th percentile vessel length was 153 mm.
- Eight of eleven CVC kits had guidewires up to 108 mm shorter than required.
- Commercial guidewires are frequently too short for optimal placement.
Conclusions:
- Avoid guidewire retraction above the brachiocephalic vein junction during CVC insertion.
- Many commercial CVC kits lack sufficient guidewire length for right subclavian vein procedures.
- Inadequate guidewire length contributes to central venous catheter misplacement.
Background:
Central venous catheter (CVC) misplacement occurs frequently after right subclavian vein catheterization. It can be avoided by using ultrasound to confirm correct guidewire tip position in the lower superior vena cava prior to CVC insertion. However, retraction of the guidewire during the CVC insertion may dislocate the guidewire tip from its desired and confirmed position, thereby resulting in CVC misplacement. The aim of this study was to determine the minimal guidewire length required to maintain correct guidewire tip position in the lower superior vena cava throughout an ultrasound-guided CVC placement in the right subclavian vein.
Methods:
One hundred adult patients with a computed tomography scan of the chest were included. By using multiplanar reconstructions from thin-sliced images, the distance from the most plausible distal puncture site of the right subclavian vein to the optimal guidewire tip position in the lower superior vena cava was measured (vessel length). In addition, measurements of equipment in common commercial over-the-wire percutaneous 15-16 cm CVC kits were performed. The 95th percentile of the vessel length was used to calculate the required minimal guidewire length for each CVC kit.
Results:
The 95th percentile of the vessel length was 153 mm. When compared to the calculated minimal guidewire length, the guidewires were up to 108 mm too short in eight of eleven CVC kits.
Conclusion:
After confirmation of a correct guidewire position, retraction of the guidewire tip above the junction of the brachiocephalic veins should be avoided prior to CVC insertion in order to preclude dislocation of the catheter tip towards the right internal jugular vein or the left subclavian vein. This study shows that many commercial over-the-wire percutaneous 15-16 cm CVC kits contain guidewires that are too short for right subclavian vein catheterization, i.e., guidewire retraction is needed prior to CVC insertion.
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