Paper
Another WIN for point-of-care ultrasound: the wire-in-needle modified Seldinger technique for ultrasound-guided central venous access.
Published Jun 1, 2013 · M. Stone, M. Mallin, J. Cook
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Abstract
Dynamic ultrasound (US) guidance is an established practice standard for the placement of central venous catheters (CVCs) as it decreases mechanical complications and improves procedural success by both internal jugular and subclavian routes. However, despite clear advantages, complications of US-guided CVC placement still occur. Inadvertent arterial cannulation and posterior vessel wall puncture have been reported in both tissue phantom models and human subjects. As a result, real-time US visualization of the guidewire has been proposed as a means to confirm target vessel cannulation prior to dilation and CVC placement. In an effort to further improve patient safety and procedural success, we have developed the wire-in-needle (WIN) technique, a novel modification of the traditional Seldinger technique, wherein the introducer needle is “preloaded” with a guidewire prior to insertion through the skin. The needle is then advanced using an in-plane, long-axis technique until venous catheterization is visualized, after which the wire is advanced into the target vessel (Video Clip S1, available as supporting information in the online version of this paper). There are several advantages to this technique: 1. We find the manual dexterity associated with grasping the hub of the introducer needle to be far superior to grasping and simultaneously aspirating a syringe. 2. In the traditional approach, especially in patients with small-caliber vessels and significant respirophasic vessel diameters, we find that the needle tip is often dislodged from the target vessel when the syringe is detached prior to introducing the guidewire. In contrast, the WIN technique allows immediate placement of the guidewire in the target vessel after vessel penetration. 3. The preloaded introducer needle has a distinctly more visible US appearance (Figure 1), thus improving the operator’s ability to visualize the needle as it progresses toward the target vessel.
The wire-in-needle technique improves patient safety and procedural success by preloading introducer needles with guidewires, allowing immediate placement of the guidewire in the target vessel after vessel penetration.
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