TY - JOUR
T1 - Image intensification - A solution for difficult guidewire insertion for central venous access
T2 - A case report
AU - Weinberg, Laurence
AU - Yii BBiomed, Matthew
AU - Li BBiomed, Michael
AU - Louis BBiomed, Maleck
AU - Lee, Dong Kyu
AU - Doolan, Laurie
N1 - Publisher Copyright:
© 2020 The Author(s)
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/2
Y1 - 2020/2
N2 - Presentation of case: A 56-year old male presented for an elective redo-sternotomy, aortic valve replacement, tricuspid valve annuloplasty, and coronary artery bypass grafting. During central vascular access using a standard Seldinger technique, resistance to two spring-wire guide wires was encountered when the wires were advanced through the patient's internal jugular vein. Ultrasound provided limited views of the anatomical path of the guidewires and was unable to provide visualisation of the level or cause of obstruction. We describe the application of continuous image intensification to successfully identify the anatomical location and safe circumnavigation of guidewire obstruction during the insertion of a central venous and pulmonary artery catheter for cardiac surgery. Discussion: The use of x-ray image intensification enabled the immediate identification of the cause of obstruction, minimising further attempts at guidewire insertion and subsequent complications. The direct real-time visualisation allowed for manoeuvres such as wire manipulation, rotation and advancement to be safely performed. Conclusion: Image intensification may decrease malposition rates and mechanical complications associated with difficult central venous catheterisation. Further research comparing the safety and efficiency of ultrasound-guided and fluoroscopy-guided CVC insertion should be contemplated.
AB - Presentation of case: A 56-year old male presented for an elective redo-sternotomy, aortic valve replacement, tricuspid valve annuloplasty, and coronary artery bypass grafting. During central vascular access using a standard Seldinger technique, resistance to two spring-wire guide wires was encountered when the wires were advanced through the patient's internal jugular vein. Ultrasound provided limited views of the anatomical path of the guidewires and was unable to provide visualisation of the level or cause of obstruction. We describe the application of continuous image intensification to successfully identify the anatomical location and safe circumnavigation of guidewire obstruction during the insertion of a central venous and pulmonary artery catheter for cardiac surgery. Discussion: The use of x-ray image intensification enabled the immediate identification of the cause of obstruction, minimising further attempts at guidewire insertion and subsequent complications. The direct real-time visualisation allowed for manoeuvres such as wire manipulation, rotation and advancement to be safely performed. Conclusion: Image intensification may decrease malposition rates and mechanical complications associated with difficult central venous catheterisation. Further research comparing the safety and efficiency of ultrasound-guided and fluoroscopy-guided CVC insertion should be contemplated.
KW - Anaesthesia
KW - Cardiac surgery
KW - Central venous catheter
KW - Guidewire
KW - Image intensification
KW - Ultrasound
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U2 - 10.1016/j.amsu.2019.12.005
DO - 10.1016/j.amsu.2019.12.005
M3 - Article
AN - SCOPUS:85077644354
VL - 50
SP - 31
EP - 34
JO - Annals of Medicine and Surgery
JF - Annals of Medicine and Surgery
SN - 2049-0801
ER -