PURPOSE: This study reports a simple technique to overcome potentially serious central venous catheter (CVC) obstructions that impede the successful smooth insertion of a guide wire during catheter replacement.
METHODS: The 5 mL Arrow Raulerson Syringe is designed with a hollow central cavity. We identified patients with resistance during guide wire insertion during central venous catheter changes. The guide wire was initially withdrawn, and a 10 mL saline flush was administered through the obstructed distal port. The guide wire was then reinserted, and if the obstruction was not relieved with the saline flush, we filled the Arrow Raulerson syringe with 5 mL saline and threaded the partially inserted guide wire through the central cavity of the syringe and connected the syringe to the hub of the distal port. We then injected the saline flush while simultaneously advancing the guide wire, which created enough lubrication to allow the wire to be advanced through the syringe and the catheter.
RESULTS: We enrolled fifteen patients with obstructed catheter lumens during CVC changes over a guide wire. The sites of CVC placement were as follows: 11 in the subclavian vein, 3 in the internal jugular vein, and 1 in the axillary vein. The mean number of days from the previous catheter insertion to the time of replacement was 8.2 days (range 1 –22 days). The mean depth at which the guide wire became obstructed was 22.6 cm (range 18 –29 cm). All 15 (100%) of the obstructed catheters were successfully replaced without complications or loss of intravenous access. 12 out of 15 catheter changes (80%) were successful with a single 5 mL saline injection, and 3 catheters (20%) required a second 5 mL injection.
CONCLUSION: Lubricating the CVC via the Arrow Raulerson syringe with saline allows for a safe and effective change over a guide wire.
CLINICAL IMPLICATIONS: We have developed a quick, simple and effective technique for overcoming CVC obstructions during catheter replacement.
DISCLOSURE: Andrew Pastewski, None.