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J Korean Soc Emerg Med > Volume 29(4); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(4): 364-370.
중심정맥관 삽입 시 초음파 유도 하 유도철사 재위치를 통한 위치이상 감소 방법
강태욱, 조성욱, 안홍준, 민진홍, 정원준, 유승, 오세광, 김승환, 유연호, 이진웅, 박정수, 유인술, 조용철
충남대학교 의과대학 응급의학교실
The method to reduce the malposition rate via reposition of guidewire with ultrasound guidance in the central venous catheterization
Taewook Kang, Sunguk Cho, Hongjoon Ahn, Jinhong Min, Wonjoon Jeong, Seung Ryu, Segwang Oh, Seunghwan Kim, Yeonho You, Jinwoong Lee, Jungsoo Park, Insool Yoo, Yongchul Cho
Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
Correspondence  Yongchul Cho ,Tel: 042-280-6002, Fax: 042-280-6014, Email: boxter73@naver.com,
Received: June 11, 2018; Revised: July 11, 2018   Accepted: July 13, 2018.  Published online: August 31, 2018.
ABSTRACT
Objective:
Malposition of central venous catheterization (CVC) may cause vascular related complications and catheter dysfunctions. The aim of this study was to reduce the malposition rate of CVC by repositioning the malposition after confirming the location of the guide-wire with ultrasound (US) guidance.
Method:
This research assessed the before study (group A) from January to December 2016 and after study (group B) from January to December 2017 in the emergency department. CVCs were performed using the anatomical landmark technique (group A) and US guided technique (group B). In group B, if the guided-wire was misplaced, it was drawn back and repositioned under US guidance. The final location of the catheter tip was confirmed by chest X-ray. The rate of malposition before and after repositioning of the two groups was compared.
Results:
The subjects were group A (694 cases) and group B (619 cases) with a total of 1,313 patients. The rate of malposition before repositioning of the two groups were 16 cases (2.3%) and 13 cases (2.1%), respectively, and no statistically significant difference was observed (P>0.05). In group B, there were 10 cases (1.6%) of guidewire malposition that was identified and three cases (0.5%) of catheter malposition could not be identified under US examination. The malpositioned guidewires were all corrected by repositioning under ultrasound guidance. The rate of malposition after repositioning of the two groups were 2.3% (n=16) and 0.5% (n=3), respectively, and a statistically significant difference was observed (P=0.009).
Conclusion:
With US guidance, confirming the location and repositioning CVC guidewire can reduce the malposition rate in CVCs.
Key words: Central venous catheterization; Malposition; Moving and lifting patients; Ultrasonography
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