Visibility of guidewires in ultrasound-guided internal jugular double lumen catheterization

Abstract

The diameter of a hemodialysis double lumen catheter (DLC) and its dilator is markedly larger than its introducer needle. It is, therefore, crucial to rule out inadvertent arterial guidewire misplacement before inserting the dilator. For that reason, after inserting a guidewire in the internal jugular vein, we obtain a short axis ultrasound view of the guidewire proximal to the heart by tilting an ultrasound probe at the medial supraclavicular fossa. In this study, we analyzed an optimized guidewire for this procedure. First, ultrasound visibility of three different hemodialysis DLC guidewires was compared in a simulator. Visibility of the guidewire of 0.97mm in diameter was superior at an ultrasound incident angle of 40 degrees compared to that at 90 degrees. On the contrary, visibility of the guidewires of 0.64 and 0.46mm in diameter was inferior at 40 degrees compared to that at 90 degrees. Second, ultrasound visibility of the two different guidewires was compared in patients. The visibility of the guidewire of 0.64mm in diameter was inferior to that of 0.97mm in diameter; therefore, it took more time to confirm the successful insertion of the former in the brachiocephalic vein. Conclusion : Using larger guidewires showing superior ultrasound visibility and visualization of the guidewire, appropriate venous placement can be confirmed before inserting a dilator.