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Confirmation of internal jugular guide wire position utilizing transesophageal echocardiography

[Confirmation de la position d'un guide métallique dans la veine jugulaire interne en utilisant l'échocardiographie transsophagienne]

From the Department of Anesthesia, McMaster University, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada.

Address correspondence to: Dr. Fayad, Department of Anesthesia, Hamilton Health Sciences Corporation, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. Phone: 905-521-2100; Fax: 905-523-1224; E-mail: fayad{at}attcanada.ca

Purpose: To describe the utility of transesophageal echocardiography (TEE) in confirmation of correct central line J-wire position.

Clinical features: A 51-yr-old male patient presented for urgent coronary artery bypass grafting. Current medications included aspirin, nitroglycerine, heparin and a B-blocker. Physical examination was unremarkable. Initial difficulty with right internal jugular vein cannulation was encountered. A posterior approach was used to access the vein with further difficulty in passing the J-wire. Simultaneous TEE images confirmed the correct J-wire position.

Conclusion: The case demonstrates the value of TEE to confirm correct guide wire position prior to insertion of a large bore central venous catheter. TEE visualization of J-wire position avoided repeat attempts at internal jugular cannulation and potential carotid artery puncture.