title: Confirmation of internal jugular guide wire position utilizing transesophageal echocardiography.
abstract: OBJECTIVE
  To describe the utility of transesophageal echocardiography (TEE) in confirmation of correct central line J-wire position.
  
  
  METHODS
  A 51-yr-old male patient presented for urgent coronary artery bypass grafting. Current medications included aspirin, nitroglycerine, heparin and a B-blocker. Physical examination was unremarkable. Initial difficulty with right internal jugular vein cannulation was encountered. A posterior approach was used to access the vein with further difficulty in passing the J-wire. Simultaneous TEE images confirmed the correct J-wire position.
  
  
  CONCLUSIONS
  The case demonstrates the value of TEE to confirm correct guide wire position prior to insertion of a large bore central venous catheter. TEE visualization of J-wire position avoided repeat attempts at internal jugular cannulation and potential carotid artery puncture.
authors.affiliation: Department of Anesthesia, McMaster University, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Sawchuk
authors.forename: A
authors.initials: A
authors.lastname: Fayad
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods*; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged