Subclavian vein catheterization in the emergency department: a comparison of guidewire and nonguidewire techniques.

Guidewire catheters have been used with increasing frequency during the last several years for placement of central venous lines. No data exist comparing success and complication rates of guidewire and nonguidewire catheterization in the emergency setting. A prospective, randomized study was conducted to compare GW and NGW central venous catheterization (CVC) by the infraclavicular subclavian approach. The study consisted of 210 patients (87 trauma, 123 medical) requiring a CVC as part of their emergency department care. Catheter placement and complications were determined by immediate chest radiograph, two-day followup, and chart review after discharge. Results demonstrated no statistically significant differences in success rates or complications, with the exception of catheter malfunction due to extrathoracic vascular placement or catheter kinkage. This complication occurred more frequently when the guidewire technique was used. The guidewire CVC technique does not appear to offer any improvement of complication rates when compared to the nonguidewire technique.