Novel Use of Central Venous Catheter Dilator

Abstract

Dear SirExternal jugular vein (EJV) approach is one of the safe and effective routes for central venous cannulation. [1Chakravarthy M Krishnamoorthy J Nallam S Kolur N Faris A Reddy K External Jugular Venous Route for Central Venous Access: Our Experience in 563 Surgical Patients. Journal of Anesthesia & Clinical Research [Internet]. 2012 Feb 1 [cited 2016 May 2].Available from: http://www.omicsonline.org/anesthesia-clinical-research-abstract.php?abstract_id=152Date: 2011Google Scholar]. As cannulation through EJV is not always successful; many methods have been discussed in the literature to increase the success rate. [2Segura-Vasi AM Suelto MD Boudreaux AM External jugular vein cannulation for central venous access.Anesthesia Analgesia. 1999; 88: 692-693Crossref PubMed Google Scholar,3Sparks CJ McSkimming I George L Shoulder manipulation to facilitate central vein catheterization from the external jugular vein.Anaesthesia and Intensive Care. 1991; 19: 567-568PubMed Google Scholar]. Usually EJV cannulation is done through needle provided in the central venous cannula set (Certofix® Trio V720, BBraun Melsungen AG, Made in Germany). But it may require multiple puncture of the EJV due to presence of valves in the EJV. [4Nishihara J Takeuchi Y Miyake M Nagahata S Distribution and morphology of valves in the human external jugular vein: indications for utilization in microvascular anastomosis.Journal of Oral and Maxillofacial Surgery. 1996; 54: 879-882Abstract Full Text PDF PubMed Scopus (13) Google Scholar]. Intravenous (IV) cannulae have been used routinely to reduce multiple puncture of EJV. A 16 Gauge (G) IV cannula (Vasofix Safety Pur 16 G, Imported & Marketed by: BBraun Medical India Pvt Ltd, Bhiwandi, India)is used routinely for 7Fr central venous catheterization (figure 1A). Figure 1 Recently, IV cannulae with safety shields (to prevent needle stick injuries) have become widely available to prevent needle stick injury. When this type of cannula is used for central venous cannulation, we noticed difficulty in passing the ‘J' tip of guide wire beyond catheter hub. As the guide wire introducer is connected to the cannula hub, a small gap exists between them. This gap acts as a potential exit space for the tip of guide wire to bend as 'J’ and prevents it entering the lumen of thecannula. (figure 1B) We started interposing the dilator (provided with the CVC set) between the cannula and guide wire introducer, this assembly made guide wire insertion easy. As the dilator snuggly fits into the hub of the cannula, it abolishes the potential space and aids the passage of the guide wire through IV cannula. (figure 1C) We suggest this technique in cases of difficult passage of guidewire, as it is a simple and safe technique without need for additional equipment. Conflict of Interest: