The method to reduce the malposition rate via reposition of guidewire with ultrasound guidance in the central venous catheterization

Kang, Taewook; Cho, Sunguk; Ahn, Hongjoon; Min, Jinhong; Jeong, Wonjoon; Ryu, Seung; Oh, Segwang; Kim, Seunghwan; You, Yeonho; Lee, Jinwoong; Park, Jungsoo; Yoo, Insool; Cho, Yongchul

Abstract

OBJECTIVE
Malposition of central venous catheterization (CVC) may cause vascular related complications and catheter dysfunctions. The aim of this study was to reduce the malposition rate of CVC by repositioning the malposition after confirming the location of the guide-wire with ultrasound (US) guidance.
METHODS
This research assessed the before study (group A) from January to December 2016 and after study (group B) from January to December 2017 in the emergency department. CVCs were performed using the anatomical landmark technique (group A) and US guided technique (group B). In group B, if the guided-wire was misplaced, it was drawn back and repositioned under US guidance. The final location of the catheter tip was confirmed by chest X-ray. The rate of malposition before and after repositioning of the two groups was compared.
RESULTS
The subjects were group A (694 cases) and group B (619 cases) with a total of 1,313 patients. The rate of malposition before repositioning of the two groups were 16 cases (2.3%) and 13 cases (2.1%), respectively, and no statistically significant difference was observed (P>0.05). In group B, there were 10 cases (1.6%) of guidewire malposition that was identified and three cases (0.5%) of catheter malposition could not be identified under US examination. The malpositioned guidewires were all corrected by repositioning under ultrasound guidance. The rate of malposition after repositioning of the two groups were 2.3% (n=16) and 0.5% (n=3), respectively, and a statistically significant difference was observed (P=0.009).
CONCLUSION
With US guidance, confirming the location and repositioning CVC guidewire can reduce the malposition rate in CVCs.