Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Sweden.
Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University, Lund, Sweden.
J Vasc Access. 2022 May;23(3):375-382. doi: 10.1177/1129729821993983. Epub 2021 Feb 14.
Central venous catheter (CVC) misplacement occurs frequently after right subclavian vein catheterization. It can be avoided by using ultrasound to confirm correct guidewire tip position in the lower superior vena cava prior to CVC insertion. However, retraction of the guidewire during the CVC insertion may dislocate the guidewire tip from its desired and confirmed position, thereby resulting in CVC misplacement. The aim of this study was to determine the minimal guidewire length required to maintain correct guidewire tip position in the lower superior vena cava throughout an ultrasound-guided CVC placement in the right subclavian vein.
One hundred adult patients with a computed tomography scan of the chest were included. By using multiplanar reconstructions from thin-sliced images, the distance from the most plausible distal puncture site of the right subclavian vein to the optimal guidewire tip position in the lower superior vena cava was measured (vessel length). In addition, measurements of equipment in common commercial over-the-wire percutaneous 15-16 cm CVC kits were performed. The 95th percentile of the vessel length was used to calculate the required minimal guidewire length for each CVC kit.
The 95th percentile of the vessel length was 153 mm. When compared to the calculated minimal guidewire length, the guidewires were up to 108 mm too short in eight of eleven CVC kits.
After confirmation of a correct guidewire position, retraction of the guidewire tip above the junction of the brachiocephalic veins should be avoided prior to CVC insertion in order to preclude dislocation of the catheter tip towards the right internal jugular vein or the left subclavian vein. This study shows that many commercial over-the-wire percutaneous 15-16 cm CVC kits contain guidewires that are too short for right subclavian vein catheterization, i.e., guidewire retraction is needed prior to CVC insertion.
在右侧锁骨下静脉置管后，中心静脉导管（CVC）常发生错位。在插入 CVC 之前，使用超声确认导丝尖端在下腔静脉的正确位置，可以避免这种情况的发生。然而，在插入 CVC 过程中导丝的回缩可能会导致导丝尖端从期望和确认的位置错位，从而导致 CVC 错位。本研究旨在确定在超声引导下经右侧锁骨下静脉置管过程中，导丝尖端在整个下腔静脉内保持正确位置所需的最小导丝长度。
纳入了 100 例接受胸部 CT 扫描的成年患者。通过对薄层图像进行多平面重建，测量从右锁骨下静脉最可能的远端穿刺点到下腔静脉最佳导丝尖端位置的距离（血管长度）。此外，还对常见商业经皮 15-16cm 导丝式 CVC 套件的设备进行了测量。采用 95%的血管长度作为计算每个 CVC 套件所需最小导丝长度的依据。
血管长度的 95%分位数为 153mm。当将导丝长度与计算出的最小导丝长度进行比较时，在 11 个 CVC 套件中的 8 个中，导丝长度短了 108mm 之多。
在确认导丝位置正确后，在插入 CVC 之前应避免将导丝尖端回缩至上腔静脉与头臂静脉交界处之上，以防止导管尖端向右侧颈内静脉或左侧锁骨下静脉脱位。本研究表明，许多商业经皮 15-16cm 导丝式 CVC 套件中的导丝长度过短，不适合右侧锁骨下静脉置管，即需要在插入 CVC 之前回缩导丝。
