Where is the Guidewire? Confirmation of Central Catheter Placement in the Brachiocephalic Vein Using Y-shape Visualization by Ultrasound.

Tayfun Aydın,Onur Balaban,Rabia Koçulu,Murat Emre Tokur

doi:10.7759/cureus.4124

Abstract

Central venous catheter placement with ultrasound guidance improves the success rate and reduces the number of puncture attempts and complications. Y-shape visualization of central veins using an endocavity micro-convex ultrasound probe is a new technique, which has been used for brachiocephalic vein cannulation. Since the jugular, subclavian, and brachiocephalic veins can be visualized in a single view using the Y-shape technique, it can also be used to confirm the correct placement of the catheter or guidewire. We aimed to present a case in which the location of the guidewire was verified by Y-shape visualization with an endocavity micro-convex probe after a cannulation attempt. Successful internal jugular vein catheterization was achieved with the assistance of the Y-shape imaging technique and the patient was avoided from multiple cannulation attempts.

Highlights

Central venous catheterization (CVC) is an invasive procedure performed perioperatively in emergency departments and critical care units due to various indications [1]
Y-shape visualization of central veins using an endocavity micro-convex ultrasound probe is a new technique, which has been used for brachiocephalic vein cannulation
We aimed to present a case in which the location of the guidewire was verified by Y-shape visualization with an endocavity micro-convex probe after a cannulation attempt

Summary

Introduction

Central venous catheterization (CVC) is an invasive procedure performed perioperatively in emergency departments and critical care units due to various indications [1]. We could not verify the placement of the guidewire in the jugular vein with manipulation under US visualization For this reason, we thought that the guidewire should be checked with an endocavity micro-convex probe before the dilatation of the. We visualized the right brachiocephalic vein using an endocavity micro-convex probe by placing it in the triangular area, which is called the omoclavicular acoustic window (Figure 2). We used a 5-8 MHz micro-convex endocavity probe (Mindray® Bio-Medical Electronics Co Ltd., Shenzhen, China) with an optimal imaging depth, which was set at 8 cm With this method, a Y-shape is visualized, representing the jugular, subclavian, and brachiocephalic veins in the coronal plane (Figure 3). Placement of the endocavity micro-convex US probe on the supraclavicular fossa for visualization of the jugular, subclavian, and brachiocephalic veins as a Y-shape. We placed a triple-lumen 7 French central venous catheter (Arrow-Howes; Arrow International, Reading, PA, US) over the guidewire and fixed it in the proper position

Discussion

Conclusions

Findings

Disclosures