J Korean Soc Emerg Med.  2018 Dec;29(6):636-640. 10.0000/jksem.2018.29.6.636.

Does the direction of J-tip of the guide-wire influence the misplacement of subclavian catheterization?

• Kang C
• Cho S
• Ahn H
• Min J
• Jeong W
• Ryu S
• Oh S
• Kim S
• You Y
• Park J
• Lee J
• Yoo I
• Cho Y

• KMID: 2432053
• DOI: http://doi.org/10.0000/jksem.2018.29.6.636

Abstract

OBJECTIVE
Central venous catheter (CVC) misplacement can result in incorrect readings of the central venous pressure, vascular erosion, and intravascular thrombosis. Several studies have examined the correlation between the guidewire J-tip direction and misplacement rate. This study examined whether the guidewire J-tip direction (cephalad vs. caudad) affects the misplacement rate in right subclavian venous catheterization.
METHODS
This prospective randomized controlled study was conducted between February 2016 and February 2017. The subjects were divided into two groups (cephalad group vs. caudad group) and the misplacement rate was compared according to guidewire J-tip direction in each group.
RESULTS
Of 100 patients, the cephalad and caudad groups contained 50 patients each. The age, sex, and operator experience were similar in the two groups. In the cephalad group, misplacement of CVC insertion into the ipsilateral internal jugular vein occurred in two cases. In the caudad group, misplacement of CVC insertion into the contralateral subclavian vein occurred in one case, with loop formation in the brachiocephalic trunk in one case. Guidewire J-tip direction showed no significant correlation with CVC misplacement.
CONCLUSION
The guidewire J-tip direction does not influence the rate of misplacement.

Keyword

Catheterization; Central venous catheters; Subclavian vein

MeSH Terms

Brachiocephalic Trunk
Catheterization*
Catheters*
Central Venous Catheters
Central Venous Pressure
Humans
Jugular Veins
Prospective Studies
Reading
Subclavian Vein
Thrombosis