[Longitudinal Ultrasonography Detected a Guidewire Outside the Internal Jugular Vein Left during Adult Central Venous Catheter Placement].

Abstract

A 58-year-old man (height, 160.5 cm; weight 46.7 kg) underwent partial esophagectomy under general anesthesia. A resident anesthesiologist punctured the right internal jugular vein (IJV) (20 mm wide, 4.7-7.6 mm long antero-posteriorly, and 7.6 mm deep) with a 22-gauge metal puncture needle under ultrasono- graphic guidance to secure a central venous catheter (CVC) after surgery under artificial respiration. After obtaining venous blood return without an ultrasono- graphic image of the needle tip inside the IJV, the anesthesiologist advanced a flexible straight-type guidewire into the IJV without resistance. Longitudinal ultrasonography of the guidewire outside the IJV indi- cated extravasation. After withdrawing the guidewire, the anesthesiologist re-punctured the IJV. After obtain- ing blood return with two-echo enhancement inside the IJV, indicating the needle tip, the anesthesiologist advanced the guidewire without resistance and ultra- sonographically confirmed the course of the guidewire inside the IJV along the posterior wall. CVC placement was confirmed via plain radiography of the chest Even a flexible guidewire can penetrate the IJV at posterior wall if a puncture needle tip is positioned near the pos- terior wall Longitudinal ultrasonographic imaging of guidewires can help physicians avoid misplacing dila- tors.