Korean J Crit Care Med.  2015 Nov;30(4):280-285. 10.4266/kjccm.2015.30.4.280.

Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter

• Ahn BJ
• Cho SU
• Jeong WJ
• You YH
• Ryu S
• Lee JW
• Yoo IS
• Cho YC

• KMID: 2156181
• DOI: http://doi.org/10.4266/kjccm.2015.30.4.280

Abstract

BACKGROUND
We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location.
METHODS
In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downward-directed group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium.
RESULTS
Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the J-tip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114).
CONCLUSIONS
The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.

Keyword

catheterization, central venous; jugular vein; malposition

MeSH Terms

Catheterization
Catheterization, Central Venous
Catheters*
Central Venous Catheters
Emergency Service, Hospital
Heart Atria
Humans
Incidence
Jugular Veins*
Radiography
Random Allocation
Subclavian Vein
Thorax
Vena Cava, Superior

Figure

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  Fig. 1. Flow chart of enrolled patients in this study. Group A; the J-tip medial directed group, Group B; the J-tip lateral directed group, Group C; the J-tip downward directed group. CVC: central venous catheterization.

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  Fig. 2. Three different directions of the J-tip of the guidewire in central venous catheterization using the right internal jugular vein. (A) The J-tip medial-directed group (Group A), (B) the J-tip lateral-directed group (Group B), (C) the J-tip downward-directed group (Group C).

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  Fig. 3. Malpositioned tips of the central venous catheter (black arrow) shown in chest X-ray anteriorposterior view. (A) Ipsilateral insertion into the axillary vein via the right SCV, (B) Contralateral insertion into the right SCV, (C) Loop formation in the SVC. SCV: subclavian vein; SVC: superior vena cava.

Reference

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