Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter
10.4266/kjccm.2015.30.4.280
- Author:
Byeong Jun AHN
1
;
Sung Uk CHO
;
Won Joon JEONG
;
Yeon Ho YOU
;
Seung RYU
;
Jin Woong LEE
;
In Sool YOO
;
Yong Chul CHO
Author Information
1. Department of Emergency Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea. boxter73@cnuh.co.kr
- Publication Type:Randomized Controlled Trial
- Keywords:
catheterization, central venous;
jugular vein;
malposition
- MeSH:
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
- From:The Korean Journal of Critical Care Medicine
2015;30(4):280-285
- CountryRepublic of Korea
- Language:English
-
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.
