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LETTER TO EDITOR
Year : 2014  |  Volume : 8  |  Issue : 1  |  Page : 141-142

A simple technique to avoid difficulty in guide wire insertion during pediatric central venous cannulation


Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Arvind Chaturvedi
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.125980

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Date of Web Publication1-Feb-2014
 


How to cite this article:
Dube SK, Chaturvedi A. A simple technique to avoid difficulty in guide wire insertion during pediatric central venous cannulation. Saudi J Anaesth 2014;8:141-2

How to cite this URL:
Dube SK, Chaturvedi A. A simple technique to avoid difficulty in guide wire insertion during pediatric central venous cannulation. Saudi J Anaesth [serial online] 2014 [cited 2020 Feb 22];8:141-2. Available from: http://www.saudija.org/text.asp?2014/8/1/141/125980

Sir,

Percutaneous central venous cannulation (CVC) using Seldinger technique is a routinely performed procedure both in the operation theatre and intensive care unit. But a frequently encountered problem particularly during pediatric CVC is displacement of introducer needle (after localization of vein) before or during insertion of J-tip guide wire. Here we describe a simple technique to avoid this problem.

A 2-year 9-kg child was scheduled to undergo resection of a parieto-temporal glioma under general anesthesia (GA). In our patient, we tried an ultrasonography (USG) guided right internal jugular vein (IJV) cannulation under GA with a 5 Fr triple lumen central venous catheter (Certifix Trio; B. Braun, Melsungen AG). Venous puncture and introducer needle placement was made in first attempt, but in spite of our best efforts we were unable to introduce the guide wire into the IJV due to the frequent displacement of the introducer needle either during detachment of the syringe or during introduction of guide wire. So we used a 22G intravenous cannula (IC) instead of the introducer needle for IJV cannulation and after locating the IJV under USG guidance we passed the total length of sheath of the IC into IJV and withdrew its stylet. However, as there was difficulty in passage of the guide wire into the IC sheath through its curve end we had to introduce the guide wire through its straight end [Figure 1] very gently keeping a close watch on the electrocardiogram (ECG). We are now following this technique routinely for all pediatric IJV cannulations (using 22G and 24G IC in infants and neonates respectively) with 100% first attempt successful placement of the guide wire and the central venous catheter without any complication.
Figure 1: Sheath of 22G intravenous catheter (with straight end of J tip guide wire) inside right internal jugular vein

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Use of USG is now considered as a standard of care for IJV cannulation. [1] Real-time US guidance has been shown to improve the technical efficiency and efficacy of internal jugular venous and has also decreased the frequency of procedure related complications. [2] We agree that use of USG has advantage in terms of identification of the local anatomy, but our problem of displacement of introducer needle persisted in spite of use of USG. So we used the IC to deal with the problem. However, there are two problems with our techniques. First, there is chance of distortion of the IVC sheath during guide wire insertion which can cause extra-vascular migration of the IC sheath (especially during use of smaller IC) and secondly, there is chance of injury to the surrounding structures during introduction of straight end of the guide wire. However, the advancement of sheath of IC completely into the central vein will prevent the distortion and/or extra-vascular migration of the IVC sheath [3] and we introduced the guide wire very gently keeping a close watch on ECG so as to avoid injury to the surrounding structures during guide wire insertion. Our report highlights a common problem encountered during USG guided pediatric IJV cannulation and a simple technique to deal with it.

 
  References Top

1.Milling TJ Jr, Rose J, Briggs WM, Birkhahn R, Gaeta TJ, Bove JJ, et al. Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: The Third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med 2005;33:1764-9.  Back to cited text no. 1
    
2.Troianos CA, Jobes DR, Ellison N. Ultrasound-guided cannulation of the internal jugular vein. A prospective, randomized study. Anesth Analg 1991;72:823-6.  Back to cited text no. 2
    
3.Nakayama S, Takahashi S, Toyooka H. Curved-end guidewire for central venous cannulation in neonate. Anesth Analg 2003;97:917-8.  Back to cited text no. 3
    


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