title: Needle and guidewire visualization in ultrasound-guided internal jugular vein cannulation.
abstract: OBJECTIVE
  Reimbursement for ultrasound-guided central lines requires documenting the needle entering the vessel lumen. We hypothesized that physicians often successfully perform ultrasound-guided internal jugular (IJ) cannulation without visualizing the needle in the lumen and that guidewire visualization occurs more frequently.
  
  
  METHODS
  This prospective, observational study enrolled emergency physicians performing ultrasound-guided IJ cannulations over an 8-month period. Physicians reported sonographic visualization of the needle or guidewire and recorded DVD images for subsequent review. Outcome measures were the proportion of successful procedures in which the operator reported seeing the needle or guidewire in the vessel lumen and the proportion of successful, recorded procedures, in which a reviewer noted the same findings. Procedures were deemed successful when functioning central venous catheters were placed. Fisher exact test was used for comparisons.
  
  
  RESULTS
  Of 41 attempted catheterizations, 35 (85.4%) were successful. Eighteen of these were recorded on DVD for review. The operator reported visualizing the needle within the vessel lumen in 23 (65.7%) of 35 successful cannulations (95% confidence interval [CI], 47.7%-80.3%). In 27 cases, the operator attempted to view the guidewire and reported doing so in 24 cases (88.9%; 95% CI, 69.7%-97.1%). On expert review, the needle was seen penetrating the vessel lumen in 1 (5.6%) of 18 cases (95% CI, 0.3%-29.4%). Among recorded procedures in which the operator also attempted wire visualization, the reviewer could identify the wire within the vessel lumen in 12 (75.0%) of 16 cases (95% CI, 47.4%-91.7%).
  
  
  CONCLUSIONS
  During successful ultrasound-guided IJ cannulation, physicians can visualize the guidewire more readily than the needle.
authors.affiliation: Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA. james.moak@virginia.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Moak
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Wright
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D057785:Catheters; D002983:Clinical Competence; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D009339:Needles; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted; D018084:Ultrasonography, Interventional; D055815:Young Adult