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Introduction
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
In contemporary practice, it is more common to use a modified Seldinger technique. In this technique, a sharp-ended needle (with a bevelled tip and no inner stylet) is advanced through the anterior wall of the artery until pulsatile flow of blood is seen coming out of the needle. A wire is then passed through the needle, with further steps as for the standard Seldinger technique to secure sheath access into the artery. The advantage of the modified Seldinger technique is that the posterior wall of the artery is not breached, resulting in less risk of bleeding from the posterior wall and subsequent haematoma formation. There is, however, an increased risk of subintimal passage of the guidewire, particularly if the bevel of the needle is partly within the arterial wall and partly within the lumen. The risk can be reduced by use of ultrasound to guide the puncture, especially in patients with a weak or absent pulse. Once arterial access has been secured with a sheath, appropriate guide wires and catheters can then be passed through it for diagnostic studies and interventions (Fig. 1.66c).
A narrative review of historic and current approaches for patients with difficult venous access: considerations for the emergency department
Published in Expert Review of Medical Devices, 2022
Andrew Little, Drew G. Jones, Kimberly Alsbrooks
In a prospective convenience study, where PIV catheters were placed in the IJ vein, seven patients received the guidewire-assisted intravenous catheter under ultrasound guidance. This study revealed that the guidewire-assisted intravenous catheter was associated with a low procedure time of four minutes and no catheter-related complications, such as arterial puncture [28]. This study demonstrated faster time for overall procedure compared to central catheter, a lower risk of complications compared to historic standards of care, and minimized resource wastage (i.e. central catheter kit components). When considering pre-sterile preparation (e.g. collect materials), sterile preparation and anesthesia (e.g. drape, gown, skin antiseptic, lidocaine injection), insertion (e.g. cannulation, insertion of guidewire, dilation, and advancement of the catheter), and post-insertion steps (e.g. remove drape, dress the device, dispose all personal protective equipment), literature evidence suggests that placing a central catheter may take up to 20 minutes [42]. In comparison, placing a guidewire-assisted intravenous catheter using the Easy-IJ technique has been shown to simplify the process and reduce total procedure time to four minutes [28]. The absence of complications observed may be attributed to the catheter’s length of 2.25 in, which is designed to decrease the likelihood of catheter dislodgment (often associated with short PIV catheters) and perforating nearby structures (often associated with long PIV catheters). With an anchored guidewire, the risk of losing the guidewire or advancing the guidewire too far during the procedure can also be minimized. Additionally, the risk of guidewire embolism is eliminated. A summary of the efficacy and safety outcomes comparing the guidewire-assisted intravenous catheter and other devices placed under the Easy-IJ technique can be found in Figures 1 and 2. In one case report, the guidewire-assisted intravenous catheter was placed in a patient who had multiple arteriovenous shunts in the upper extremities, leading to scarring on the skin of her upper extremities. Due to patient’s request to avoid venous dilation of the left IJ vein, the guidewire-assisted intravenous catheter was placed in her left IJ under ultrasound-guidance. The author noted the advantages of using the Seldinger technique without the risk of arterial puncture or venous dilation when placing the guidewire-assisted intravenous catheter, resulting in faster observed procedure time when compared to central catheters. Furthermore, since the guidewire is much shorter than those typically used for central catheters, the probability of inducing a cardiac dysrhythmia was also perceived to be minimal. In this case, the guidewire-assisted intravenous catheter was recommended for patients with challenging peripheral access.