title: Confirmation of optimal guidewire length for central venous catheter placement using transesophageal echocardiography.
abstract: OBJECTIVE
  Several authors have reported rare, but severe, complications associated with the length of the intravascular guidewire during central venous catheter placement, as the wire tip can cause cardiac arrhythmia or perforation or become trapped within the vessel. Although one report investigated the optimal guidewire length using fluoroscopy, few reports have precisely measured guidewire position using transesophageal echocardiography (TEE). Here, we investigated the appropriate intravascular length of a guidewire for right internal jugular vein approach using TEE during cardiac surgery.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  Operating room.
  
  
  METHODS
  Fifty-two patients undergoing elective cardiac surgery.
  
  
  METHODS
  The intravascular guidewire distance from the insertion site to the superior vena cava-right atrium (SVC-RA) junction was measured by TEE. Demographic factors (height, weight, age, etc) were recorded.
  
  
  RESULTS
  The mean distance from the access site to the SVC-RA junction was 17.8±1.3 cm (maximum/minimum =20.0/15.0 cm). There was a greater correlation with height than with weight or age.
  
  
  CONCLUSIONS
  We confirmed the wire tips at all cases by ultrasonography. The distance using TEE was similar to that by fluoroscopy, but TEE was more precise. Guidewire length was weakly correlated to height. About 15 cm as minimum length should be considered the limit for guidewire length in an adult, in consideration of height, to ensure patient safety during central catheter placement for right internal jugular vein approach.
authors.affiliation: Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, 1-1 Koda-cho, Shunan, Yamaguchi 745-8522, Japan. Electronic address: manabu-ygc@umin.ac.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, 1-1 Koda-cho, Shunan, Yamaguchi 745-8522, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakanishi
authors.affiliation: Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, 1-1 Koda-cho, Shunan, Yamaguchi 745-8522, Japan.
authors.forename: Seishi
authors.initials: S
authors.lastname: Sakamoto
authors.affiliation: Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, 1-1 Koda-cho, Shunan, Yamaguchi 745-8522, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Toriumi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D006348:Cardiac Surgical Procedures; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D062905:Central Venous Catheters / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Central venous catheter; Guidewire; Internal jugular vein; Transesophageal echocardiography