Confirmation of internal jugular guide wire position utilizing transesophageal echocardiography.
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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.
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