Confirmation of internal jugular vein cannulation: the Finucane technique

Arndt, George A.; Felton, Thomas; Finucane, Brendan T.; Santora, Albert H.

doi:10.1007/bf03009616

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…Measures which could have avoided this complication include using a more cephalic insertion point, limiting the depth of the needle, an in-plane ultrasound visualization approach [ 3 ], a bevel down technique [ 4 ], ultrasound to trace the distal end of the guide wire down into the thoracic inlet, four-dimensional ultrasound [ 5 ], echocardiography with or without contrast [ 6 , 7 ], a 18-G cannula with manometry [ 8 ], blood gas analysis or the Finucane technique [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

An unusual route taken by a central venous catheter resulting in inadvertent subclavian artery cannulation: a case report

Tan

Chan

Soh

2015

Oxford Medical Case Reports

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Ultrasound-guided cannulation of a central venous catheter into the internal jugular vein (IJV) was performed in the intensive care unit for a critically ill patient. The catheter was inserted into the subclavian artery distally, despite prior ultrasound confirmation of the guidewire position using both the in-plane and out-of-plane views. The catheter was removed successfully by the interventional radiologist with a closure device. To our knowledge, there have been previous case reports of subclavian artery injury during IJV cannulation with ultrasound guidance, but rarely in the setting whereby the guidewire was visualized before dilatation and railroading of the catheter. This case demonstrates that the confirmation of the guidewire in the proximal segment of the vein is insufficient to exclude arterial cannulation.

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Section: Discussionmentioning

confidence: 99%

An unusual route taken by a central venous catheter resulting in inadvertent subclavian artery cannulation: a case report

Tan

Chan

Soh

2015

Oxford Medical Case Reports

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“…One suggested technique for confirming proper vessel entry involves attaching plastic intravenous tubing to the needle after vessel penetration and observing the flow and pulsation of blood within the tubing with positional changes. 13 This technique requires holding the needle steady while the needle tip resides within the vessel lumen, is time consuming, involves extra equipment, and may not be reliable in hypotensive patients. Another method of ensuring proper vessel cannulation is to proceed with wire placement and perform blood gas analysis on the initial aspirate prior to passing a dilator over the wire.…”

Section: Discussionmentioning

confidence: 99%

The wire is really easy to see (WIRES): sonographic visualization of the guidewire by novices

Moak

Rajkumar

Woods

2013

CJEM

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Objective: To determine whether novices can distinguish between properly and improperly placed guidewires in a vascular access model after only minimal training. Methods: This was a prospective study involving trainees with no previous training in sonographic guidewire visualization. A vascular access model was created with guidewires positioned inside or adjacent to simulated veins. Subjects were taught to scan each wire to determine its location. Afterward, participants scanned a test model of five vein-wire pairs and recorded their answers as ''inside,'' ''outside,'' or ''unsure.'' The test characteristics of sonographic guidewire localization were determined using actual wire location as the criterion standard. Results: Forty trainees (21 emergency medicine residents, 19 medical students) participated, and each examined five simulated veins. There were 156 true positives (intravascular wire correctly identified), 38 true negatives (extravascular wire correctly identified), 2 false negatives, 2 false positives, and 2 cases in which the participant marked ''not sure,'' which were reclassified as false negatives. Test characteristics were sensitivity 97.5% (95% CI 93.3-99.2) and specificity 95.0% (95% CI 81.8-99.1). The overall accuracy was 97.0%. Conclusions: Sonographic guidewire visualization, a step recommended for ensuring proper vessel cannulation during central venous access, can be accomplished by novices with a high degree of accuracy. RÉ SUMÉObjectif: L'é tude visait à dé terminer si des dé butants pouvaient faire la distinction entre des fils-guides bien placé s et des fils-guides mal placé s dans un modè le d'accè s vasculaire, aprè s une formation minimale seulement. Mé thodes: Il s'agit d'une é tude prospective à laquelle ont participé des stagiaires sans formation pré alable dans la visualisation de fils-guides à l'é chographie. Un modè le d'accè s vasculaire a é té cré é , avec des fils-guides placé s à l'inté rieur ou à l'exté rieur des veines factices. Les sujets ont d'abord appris à é chographier chaque fil-guide pour dé terminer son emplacement, puis ont é chographié un modè le comptant cinq ensembles veine-fil-guide, et indiqué leurs ré ponses comme suit: « À l'inté rieur », « À l'exté rieur », ou « Incertain ». Les caracté ristiques du test sur la localisation des fils-guides à l'é chographie ont é té dé terminé es à partir de l'emplacement ré el des fils-guides, critè re constitué en norme. Ré sultats: Quarante stagiaires (21 ré sidents en mé decine d'urgence, 19 é tudiants en mé decine) ont participé à l'é tude, et chacun a examiné cinq veines factices. Il y a eu 156 vraies ré ponses positives (fil-guide intravasculaire: bonne ré ponse), 38 vraies ré ponses né gatives (fil-guide extraravasculaire: bonne ré ponse), 2 fausses ré ponses né gatives, 2 fausses ré ponses positives, et 2 ré ponses noté es « Incertain » et traité es comme fausses ré ponses né gatives. Le test avait pour caracté ristiques une sensibilité de 97.5% (IC à 95%: 93.3-99.2) et une spé cificité de 95.0% (IC à 95...

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“…Intra-1: Ausgangs-EKG intravasal, Intra-2: Deutlicher Anstieg der P-Welle, Intra-3: Maximale P-Wellen-Amplitude, Extra-1: V. brachiocephalica links, extravasal oberhalb der perikardialen Umschlagfalte, Extra-2: V. cava superior extravasal unterhalb der perikardialen Umschlagfalte, Extra-A: Aorta ascendens extravasal unterhalb der perikardialen Umschlagfalte. [10,11,19,20].…”

Section: Diskussionunclassified