J-tip Guidewire Research Articles

Catheter ablation of atrial fibrillation in a patient with interruption of the inferior vena cava complicated with persistent left superior vena cava.

A 55-year-old woman of I-IVC complicated with PLSVC underwent catheter ablation for atrial fibrillation through right jugular vein access. TSP was achieved by electrocautery and the J-tip guidewire with the help of deflectable sheath and ICE. After PVI, the CS-PLSVC and LA-PLSVC connections were ablated within PLSVC.

Surgical Removal of an Extravascular Knotted J-Tip Guidewire During Subclavian Central Venous Catheterization- A Case Report

Guidewire-related complications during central venous catheterization are relatively uncommon. However, they can still occur even with experienced physicians. This report presents a case of an extravascular knotted guidewire during central venous catheterization that required surgical removal. A 72-year-old male patient scheduled for cervical anterior interbody fusion surgery underwent left subclavian venous catheterization one day before the surgery. The J-tip guidewire was inserted through the introducer needle easily without any resistance. During the insertion of the catheter over the guidewire, the catheter did not advance more than 3 cm from the skin. The guidewire was kinked, which was further aggravated by attempts to remove it forcefully, leading to a knot formation that required surgical removal. The patient was discharged one week after the surgery without any additional complications. Safe removal of guidewires is of utmost importance, and preventive measures should be taken to reduce the risk of complications.

Use of a Guide-wire as an Adjunct for the Safe Removal of a 'Stuck' Indwelling Central Venous Catheter at Risk for Breaking.

Port-based central venous catheters may remain indwelling for years with subsequent fibrosis resulting in a "stuck" catheter. At time of removal, this can lead to complications such as catheter fracture or require additional operative techniques for safe extraction. We present a case utilizing a protocol wherein a J-tip guidewire is placed to assist in removal. We believe this serves the following beneficial functions: Mechanically, as the catheter stretches and collapses upon retraction it distributes the force circumferentially along the length of the catheter as well as reduces angular kinking, mitigating stress points of fracture. Second, in case of fracture, the distal portion should remain intubated by the J-tip guidewire, reducing embolic potential. Third, it allows more facile percutaneous transvenous retrieval if indicated. Though this does not represent a perfect solution to the "stuck" catheter problem, this technique increases safety and efficacy of removal with easy application at minimal additional cost.

Novel J-tip guidewire for reintervention after stent-by-stent placement in patients with malignant hilar biliary obstruction

Reintervention (RI) after bilateral metal stent placement for malignant hilar biliary obstruction is a highly technically challenging procedure. This study aimed to examine the use of a novel J-tip guidewire (GW) for RI after stent-by-stent (SBS) placement. The study outcomes included technical success, procedure time, and procedure-related adverse events associated with RI after SBS placement. These parameters were compared between 20 patients who underwent RI using the J-tip GW (J-GW group) and a control cohort of 20 patients who underwent RI using a conventional GW (C-GW group). The technical success rate of GW placement without any advanced technique was significantly higher in the J-GW group than that in the C-GW group. The median procedure time was significantly shorter in the J-GW group. No significant differences on the procedure-related adverse event rate were observed between the groups. The novel J-tip GW yielded higher technical success rates with appropriate GW placement and shorter procedure time for RI after SBS placement, simplifying and streamlining the RI procedure.

Straight-tip guidewire versus J-tip guidewire for central venous catheterisation in neonates and small infants: A randomised controlled trial.

Central venous catheterisation in neonates and infants is challenging because of the small size of the vessels. The curve of the J-tip guidewire causes difficulty when inserting because of the larger radius and the tilted angle of the J-tip. We hypothesised that a straight-tip guidewire can facilitate guidewire insertion and improve the first-attempt success rate of central venous catheterisation. A randomised controlled study. This study was performed between September 2018 and July 2021 in tertiary care children's hospital. We enrolled infants weighing less than 5 kg undergoing general anaesthesia. Patients were randomly allocated to the straight-tip or J-tip groups. Ultrasonography-guided catheterisation was performed using the assigned guidewire. The primary outcome was the first-attempt success rate of central venous catheterisation. The secondary outcomes included the number of guidewire insertion attempts, the time required for successful guidewire insertion, and total time for central venous catheter placement. Eighty-eight patients were studied. The straight-tip group showed a higher first attempt success rate than the J-tip group (86.3 vs. 61.3%, P = 0.007, odds ratio 4.0, 95% confidence interval (CI), 1.4 to 11.4]. Guidewire insertion attempts were higher in the J-tip group than in the straight group ( P = 0.002, odds ratio 9.6, 95% CI, 7.9 to 92.9). Although the guidewire insertion time was longer in the J-tip group ( P = 0.003, median difference 23.0 s, 95% CI, 7.0 to 48.0), the total catheterisation time was similar owing to the additional guidewire change process in the straight-tip group ( P = 0.676). In neonates or infants weighing less than 5 kg, central venous catheterisation using a flexible straight-tip guidewire can improve the first-attempt success rate compared with a J-tip guidewire. ClinicalTrials.gov, identifier: NCT03530618.

Short peripheral intravenous cannula and straight-tip guide wire in ultrasound-guided neonatal central venous catheterization

Inserting a J-tip guide-wire into a vein's lumen is often difficult when using the Seldinger or modified Seldinger technique for central venous catheterization (CVC) in newborns. This study was designed to compare the efficacy and safety of guide-wire insertion using the combination of a short peripheral intravenous cannula with a straight-tip guide-wire vs. a needle with a J-tip guide-wire for ultrasound-guided (USG) cannulation of the internal jugular vein (IJV) in newborns using an in-plane technique. One hundred and thirty newborn patients (weight, 1.4-5.2 kg) scheduled for selective or emergency surgery, were randomly assigned to either the needle group (combined with a J-tip guide-wire) or cannula group (combined with a straight-tip guide-wire). The primary outcome was the rate of successful guide-wire insertion on the first attempt. The puncture attempts, catheter placement attempts, and mechanical complications were also compared between the groups. The rate of successful guide-wire insertion on the first attempt was higher in the cannula group (97%) than in the needle group (76%) (p < 0.05, χ2 = 11.233). Moreover, fewer insertion attempts were needed in the cannula group (1.0 ± 0.2) than in the needle group (1.7 ± 1.1) (p < 0.05, 95% CI [0.449, 1.028]). The time to successful guide-wire insertion was shorter in the cannula group (63 ± 32 s) than in the needle group (92±50 s) (p < 0.05, 95% CI [14.024, 43.063]). No differences were found about other catheterization parameters and complications between the groups. The short peripheral cannula combined with a straight-tip guide-wire was superior to the needle combined with a J-tip guide-wire for USG newborn IJV catheterization in terms of successful guide-wire insertion on the first attempt and overall number of insertion attempts.

The Silverway Guidewire: An Observational Study on Successful Crossing when a Conventional J-tip Wire has failed

Aim: The aim of this observational study was to evaluate the Silverway guidewire [Asahi Intecc Co.] that is designed to guide catheters during cardiac catheterization towards the aortic valve when the standard J-tip guidewire fails because of anatomical anomalies. Materials and Methods: A total of 50 consecutive patients, in which the Silverway guidewire was used, were analyzed: procedural characteristics, such as anatomical challenges, crossing of the vessel and deliverability of the catheters were prospectively collected. This sample size was considered reasonable to describe the success, because this was the first observational study on the performance of the Silverway guidewire. Results: In the majority of procedures, transradial access was used (47 cases; 94%). The Silverway guidewire was able to cross the vessel in 98% and to deliver catheters in 92% of patients. Most anatomical challenges occurred at the radial artery level (39 cases). No clinical important complications occurred after use of the Silverway guidewire. Conclusion:The Silverway guidewire is highly successful in overcoming anatomical obstacles without vascular complications during cardiac catheterization when the J-tip guidewire fails to cross the vascular anatomy.

Hydrophilic guidewire usage under ultrasound guidance in facilitating catheter advancement during endovenous treatment of incompetent great saphenous veins.

PurposeThis study was performed To investigate the use of hydrophilic guidewires for facilitating catheter advancement during varicose vein treatment using radiofrequency ablation (RFA) or cyanoacrylate closure (CAC).MethodsFrom March 2016 to April 2019, 463 limbs of 285 with incompetent great saphenous veins were subjected to RFA (321 limbs of 197 patients) or CAC (142 limbs of 88 patients). Procedure records were reviewed for the use of a hydrophilic guidewire, reason for the guidewire usage, and diameter of the guidewire.ResultsA hydrophilic guidewire was used to facilitate catheter advancement to treat 92 of 463 limbs (19.9%). For RFA, a guidewire was used to treat 53 of 321 limbs (16.5%). Among them, 15 limbs (28.3%) had vasospasm, and 38 limbs (71.7%) had venous tortuosity. For CAC, guidewire was used for 39 of 142 limbs (27.5%). Among them, 10 limbs (25.6%) had vasospasm, 23 limbs (59.0%) had venous tortuosity, and 6 limbs (15.4%) had repeated engagement of a J-tip guidewire into the varicose tributaries. In CAC, the frequency of hydrophilic guidewire usage was higher than that in RFA (P = 0.006). All varicose vein treatment sessions were technically successful.ConclusionHydrophilic guidewire usage could facilitate catheter advancement when hindered by vasospasm, tortuosity of the saphenous vein, or repeated engagement into the varicose tributaries.

Preferential central venous catheter access with concurrent IVC filter use.

In our aging population, there is an increased incidence of concurrent IVC filter and central venous catheter use. One of the risks of concurrent use is filter embolization, which almost always occurs due to the J-tipped guidewire. In this case, we describe the successful placement of a central venous catheter in the femoral vein in a patient with an IVC filter. Some guidelines exist concerning CVC placement in patients with IVC filters, and this case highlights the benefits of placing a CVC in the femoral vein. While little research exists regarding higher rates of IVC filter embolization in internal jugular and subclavian vein access sites, we hypothesize it is due to the conical shape of IVC filters.

Cardiac Pacing Using A Guidewire In Emergency Situation

We were describing an interesting case of complete heart block (CHB) received in the emergency department (ED) with the cardiogenic shock in the life-threatening situation, who was successfully manage by cardiac pacing, initially using a J Tip guidewire (JTG) due to non-availability of temporary transvenous pacing catheter (TVPC) and later on using TVPC once available . TVPC placement is a potentially life-saving procedure that involves placing a catheter-based electrode within the right ventricle via central venous access, and then stimulating that electrode and the heart with an external pacing generator to optimize cardiac output. In the ED, the procedure can be performed either blindly or with ECG guidance and recently with USG guidance. After placement, CXR perform to verify position of TVPC as well as any procedural complication.

Successful percutaneous removal of retained J-tip guidewire: A report of two cases

Successful percutaneous removal of retained J-tip guidewire: A report of two cases

Improved technique for sheath supported contralateral limb gate cannulation in endovascular abdominal aortic aneurysm repair.

Background: To present a technique of sheath supported contralateral limb gate (CLG) cannulation of modular bifurcated stent-graft in endovascular abdominal aortic repair. Materials and methods: After totally percutaneous bilateral femoral access, the 9F introducer sheath is exchanged to a 30cm 12 fr introducer sheath over a stiff wire contralateral to the intended main stent-graft insertion side and advanced into the aorta below the lowest renal artery. Parallel to the stiff wire within the sheath an additional standard J-tip guidewire with a 5 fr Pigtail angiographic catheter is advanced to the level of the renal arteries. After main body deployment, the 12 fr introducer sheath and J-tip wire with pigtail catheter are retracted until the CLG opening level, maintaining the stiff "buddy" wire in position to support the 12 fr sheath, maintaining its distal opening close to the contralateral gate opening to achieve easy cannulation. Results: Retrospective analysis of video archive from July 2016 to February 2018 evidenced 55 recorded EVAR cases. All CLG cannulations were obtained with Standard J-tip or Terumo Glidewire wires and with Pig-Tail or Berenstein catheters. Technical success was 100%. Mean fluoroscopy time to accomplish CLG cannulation was 37.6 33 (range 1-105) seconds. The aortic carrefour angulation on coronal axis strongly correlates with cannulation time p=<.001, with longer cannulation time for higher carrefour angulations on coronal axis (Pearson correlation coefficient 0.47). Conclusions: The use of 12 fr sheath with parallel wire introduction technique, appears to be a safe and reliable tool to facilitate CLG cannulation during EVAR procedures.

Safety and Efficacy of a Small J-Tipped Guidewire for Pancreatic Duct Endoscopic Intervention.

Background and Aims The insertion of the guidewires (GWs) into the pancreatic duct is technically difficult, and there is a risk of post-ERCP pancreatitis (PEP). The aim of this study was to evaluate the safety and efficacy of a small J-tipped guidewire for pancreatic duct endoscopic intervention. Methods This single-site retrospective study was conducted to assess the procedural success rate and adverse events of endoscopic transpapillary interventions to the pancreatic duct in 114 cases using the small J-tipped GW and 180 cases using the angle-tipped GW. Results The procedural success rate was significantly higher in the small J-tipped GW group compared with that in the angle-tipped GW group (76% versus 47%, P < 0.001). The procedural success-related factors were chronic pancreatitis (OR 0.43, 95% CI 0.22–0.82, P = 0.01), flexion angle of the pancreatic duct < 90° (OR 0.50, 95% CI 0.30–0.80, P = 0.01), and use of the small J-tipped GW (OR 4.63, 95% CI 2.61–8.20, P < 0.001). The rates of total post-ERCP pancreatitis were significantly lower in the small J-tipped GW group compared with that in the angle-tipped GW group (3.5% versus 12.2%, P = 0.01). Multivariate analysis of pancreatitis risk factors indicated that only the use of the small J-tipped GW was a factor in decreasing the risk of developing pancreatitis (OR 0.12, 95% CI 0.09–0.85, P = 0.02). Conclusions Small J-tipped GWs increase the success rate of the pancreatic duct endoscopic intervention as well as a reduced risk of developing postoperative pancreatitis.

How to Improve Cannulation Rates During Endoscopic Retrograde Cholangiopancreatography

How to Improve Cannulation Rates During Endoscopic Retrograde Cholangiopancreatography

Isolated severe aortic stenosis in a tricuspid aortic valve in a 8-year-old boy

Since the first report of percutaneous retrieval of intravascular foreign body in 1964, it has been accepted as a favourite approach for intravascular foreign body removal. Snares, biopsy forceps, dormia basket or tip deflecting wires are available in the armamentarium for this approach. Herein, we report percutaneous retrieval of a dislodged J-tip guide-wire by self-constructed snare. A patient was a 75-year-old woman who was admitted with capture failure following post pacemaker implantation. J-tip guide-wire was inadvertently left in her inferior vena cava during temporary pacemaker insertion. The guide wire was approached through right subclavian vein by a self-constructed snare and it was removed without any complications. Use of snares for intravascular foreign body removal is frequently reported and has been successful with low complication rates; also, the low cost of such snares makes it safe and economical.

Endomyocardial Biopsy Technique for Orthotopic Heart Transplantation and Cardiac Stem-Cell Harvesting

IntroductionOrthotopic heart transplantation (OHT) is performed using the bicaval and pulmonary venous anastomoses or the standard (biatrial) anastomoses. The special considerations of endomyocardial biopsy after OHT using the bicaval technique, and after myocardial infarction for harvesting of cardiac stem cells, have not been described. MethodsWhen approached via the right or left internal jugular vein, important technical considerations were ultrasound guidance for vascular access; a soft, 80-cm, 0.035-inch, J-tipped guidewire; a long (23-cm), 7-Fr sheath; and a flexible 7-Fr, 50-cm bioptome. These technical aspects were helpful to avoid disruption of the superior vena cava suture line, avoid entry into the right atrial appendage or coronary sinus, avoid right ventricular free wall perforation, and provide ready access to the right ventricular septal wall. We used the same principles and technical considerations when obtaining the cardiac stem cells after myocardial infarction in patients enrolled in the CADUCEUS trial. ResultsFrom January 2002 to December 2005, 754 biopsy procedures were performed in 179 patients after OHT with the bicaval technique, using bioptome A. There was 1 occurrence of ventricular fibrillation requiring cardioversion, and no occurrence of cardiac tamponade during the procedure. From January 2006 to September 2013, 2818 biopsy procedures were performed in 1064 patients using bioptome B. No patient developed ventricular fibrillation or cardiac tamponade during the procedure. In 2010 and 2011, 23 biopsy procedures were performed in 23 patients after acute myocardial infarction, using bioptome B. No immediate complications occurred while performing these biopsies. The late occurrence of tricuspid regurgitation was not evaluated in this study. ConclusionsEndomyocardial biopsy procedures can be safely performed after OHT with the bicaval technique and after myocardial infarction for harvesting of cardiac stem cells. Ultrasound guidance for vascular access, a long guidewire and sheath, and a flexible bioptome are important features for the safe conduct of the biopsy procedure.

Su1639 Comparison of the Wire-guided Biliary Cannulation Using J-Tip and Angled-Tip Guidewire: a Prospective Multi-Center Controlled Study, the Jangle Study

Wire-guided cannulation (WGC) has become common as a biliary cannulation technique, and guidewires with various shapes of the tip (such as straight and angled tips) and materials (hardness) have been used for WGC. However, there have been apparently no reports indicating that the biliary cannulation rate changes depending on the type of guidewire used. Recently, the J-tip guidewire (JGW) has become commercially available and the biliary cannulation rate is thus expected to increase. We performed a prospective, multi-center, controlled study, and evaluated the effectiveness of JGW in biliary cannulation.

Extreme Brachial Loop

A 47-year-old man with prior right ulnar collateral ligament reconstruction presented with angina and was referred for cardiac catheterization. Right radial artery angiogram was normal ([Fig. 1][1]A, [Online Video 1][2]). A J-tip guidewire met resistance just above the elbow. A subsequent brachial

A case of guidewire embolism during central venous catheterization: Better safe than sorry!

Sir, Central venous catheterization (CVC) is a routine procedure in intensive care unit as well as in surgical patients requiring monitoring of hemodynamic variables, for medications and parentral nutrition, hemodialysis etc. The incidence of complications ranges from 5% to 29%[1] such as arterial puncture, hemothorax, pneumothorax, nerve injury, air embolism or dysrthythmias. Guidewire embolism during CVC is a rare iatrogenic complication.[2] The Seldinger technique is commonly used to cannulate the vessels.[3] We report a case of lost guidewire following internal jugular catheter placement and its successful management. A 64-year-old male, weighing 67 kg, 176 cm height had c/o hematuria since last 15 days. Patient was suffering from chronic obstructive pulmonary disease, diabetes and hypertension. Ultrasound showed bladder mass lesion, enlarged prostate, and hepatomegaly. His serum creatinine was 5.07 mg/dl, total cholesterol-18,170/cmm, serum glutamic-pyruvic transaminase-122.0 and serum glutamic oxaloacetic transaminase-118.0. In view of acute renal failure and septicemia, CVC for fluid management and drug administration was advised. During a busy night shift, a 2nd year resident was assigned to perform the procedure. The left internal jugular vein was cannulated using double lumen (Polymed Novocent Duo, 160 mm) polyurethane catheter by central approach after local infiltration, under ultrasound guidance. A J-tipped guidewire (0.035 mm, 50 cm) was introduced through the needle followed by dilatation of the tract with a dilator (8.5 Fr, 4 inches) and insertion of the catheter on the guidewire. During this procedure, the guidewire was inadvertently pushed further ahead into the vein. This went unnoticed by the resident, who tried to aspirate blood from both the lumen to confirm proper positioning of the catheter. Due to inability to aspirate free flow of blood from one of the lumen, the resident flushed saline through that lumen, which could have resulted in embolization of the guidewire. After completion of the procedure, he realized that the guidewire was missing and informed the seniors. An urgent chest X-ray [Figure 1] and X-ray kidneys, ureters, and bladder [Figure 2] were done in which guidewire was clearly visible. It was removed by gooseneck snare device through femoral percuteneous approach under local anesthesia and fluoroscopic guidance without any complication. Figure 1 Chest X-ray showing guidewire Figure 2 X-ray kidneys, ureters, and bladder showing embolized guidewire For the management of guidewire embolism, if the guidewire has embolized systemically, chest X-ray and if required X-ray abdomen will determine the position of the guidewire. The percutaneous method of extraction has fewer complications for which interventional radiology techniques such as dormia basket, gooseneck snare, endovascular forceps are preferable.[4] Cheddie and Sing[5] describe a similar approach for guidewire extraction using a goose snare device. Our take home massage is that, the complications of CVC should be kept in mind during cannulation. The guidewire should not be inserted too far as average distance from all access site is 18 cm. One should hold the guidewire tip firmly while introducing the catheter and should check the guidewire outside before flushing the percutaneous catheter. Without free flow of blood during aspiration, one should not flush the catheter. Gooseneck snare technique is safe for removal of embolized guidewire.

Abstract No. 383 - Redesigning the dilator tip, what’s the point?

Purpose Progressive dilatation of tracts is used for insertion of catheters over guidewires overcoming the resistance of soft tissues. Current dilator tips have a conical design. The purpose of our study is to evaluate different tip shapes ease of insertion compared with the conical shape. Materials and Methods In-vitro study using 14 FR dilators with conical, biconvex, triangular and diamond tip designs, a 19 gauge thin wall Seldinger needle, a 0’035” 3 mm J-tip guidewire, shaped transparent Perma-Gel Ballistic gel blocks (mimicking tissue) and an ad-hoc designed scale to measure the force needed for dilator insertion into the gel. Simulation of actual use of the dilators, an initial through and through penetration of the simulated tissue was made with the needle allowing a guide wire to be placed. After threading each dilator on the guide wire, progressive force was applied to the dilator until penetration in the gel was achieved. A total of 20 trials were carried out for each dilator. The applied force to advance the dilator into the gel was recorded and compared. Results Mean value insertion forces for each tip shapes were: conical 381.44 ± 9.1 grams (3.74 ± 0.09 Newtons); biconvex 350.51 ± 18.08 (3.43 ± 0.18 Newtons); triangular 359.21 ± 15.21 grams (3.52 ± 0.15 Newtons); diamond 353.52 ± 11.87 grams (3.46 ± 0.12 Newtons). The biconvex, triangular, and diamond tips had statically significant insertion forces to penetrate the gel as compared with the conical tip (p = Conclusion Our in vitro data suggests that there are measurable differences in the applied force necessary for tissue penetration of different dilator tip designs. These findings may assist in new dilators/catheters tip design to ease soft tissue insertion.