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Title: Image intensification - A solution for difficult guidewire insertion for central venous access: A case report.
Austin Authors: Weinberg, Laurence ;Yii, Matthew;Li, Michael;Louis, Maleck ;Lee, Dong Kyu;Doolan, Laurie
Affiliation: Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Dept. of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Guro-Gu, Seoul, 08308, Republic of Korea
Issue Date: Feb-2020 2020-01-03
Publication information: Annals of medicine and surgery 2020; 50: 31-34
Abstract: 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. 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. 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.
DOI: 10.1016/j.amsu.2019.12.005
ORCID: 0000-0001-7403-7680
Journal: Annals of medicine and surgery
PubMed URL: 31956408
ISSN: 2049-0801
Type: Journal Article
Subjects: Anaesthesia
Cardiac surgery
Central venous catheter
Image intensification
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