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J Korean Soc Emerg Med > Volume 29(6); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(6): 636-640.
Does the direction of J-tip of the guide-wire influence the misplacement of subclavian catheterization?
Changshin Kang, Sunguk Cho , Hongjoon Ahn , Jinhong Min , Wonjoon Jeong , Seung Ryu , Segwang Oh , Seunghwan Kim , Yeonho You , Jungsoo Park , Jinwoong Lee , Insool Yoo , Yongchul Cho
Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
Correspondence  Yongchul Cho ,Tel: 042-280-6002, Fax: 042-280-6014, Email: boxter73@naver.com,
Received: May 11, 2018; Revised: October 2, 2018   Accepted: October 18, 2018.  Published online: December 31, 2018.
ABSTRACT
Objective:
Central venous catheter (CVC) misplacement can result in incorrect readings of the central venous pressure, vascular erosion, and intravascular thrombosis. Several studies have examined the correlation between the guidewire J-tip direction and misplacement rate. This study examined whether the guidewire J-tip direction (cephalad vs. caudad) affects the misplacement rate in right subclavian venous catheterization.
Method:
This prospective randomized controlled study was conducted between February 2016 and February 2017. The subjects were divided into two groups (cephalad group vs. caudad group) and the misplacement rate was compared according to guidewire J-tip direction in each group.
Results:
Of 100 patients, the cephalad and caudad groups contained 50 patients each. The age, sex, and operator experience were similar in the two groups. In the cephalad group, misplacement of CVC insertion into the ipsilateral internal jugular vein occurred in two cases. In the caudad group, misplacement of CVC insertion into the contralateral subclavian vein occurred in one case, with loop formation in the brachiocephalic trunk in one case. Guidewire J-tip direction showed no significant correlation with CVC misplacement.
Conclusion:
The guidewire J-tip direction does not influence the rate of misplacement.
Key words: Catheterization; Central venous catheters; Subclavian vein
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