INCIDENCE AND RISK-FACTORS OF GUIDEWIRE-INDUCED ARRHYTHMIA DURING INTERNAL JUGULAR VENOUS CATHETERIZATION - COMPARISON OF MARKED AND PLAIN J-WIRES

Study Objectives: To compare the incidence and risk factors guidewire- induced arrhythmia (GIA) during internal jugular venous catheterizatio n (IJV). Design: Prospective study. Setting: Operating rooms at a medi cal center. Patients: 303 ASA physical status I, II, III, and IV patie nts undergoing elective surgery. Interventions: All patients were cann ulated with the central venous catheters placed via the right internal jugular vein after induction of anesthesia. They were randomly divide d into two groups. in one group, we used a marked J-wire and inserted up to, but not beyond 20 cm (Group M, n = 127). In the other group, a plain unmarked J-wire was used and inserted at will (Group UM, n = 176 ). All IJV catheterizations were performed by residents, and the lengt h of J-wire inserted was then measured. Measurements and Main Results: Types of arrhythmia [eg, premature atrial contraction (PAC) or premat ure ventricular contraction (PVC)] were interpreted by attending anest hesiologists on lead II ECG. Patients in Group UM had a significantly greater incidence of GIA than those in Group M (28.4% vs. 3.9%; p < .0 05). However, in both groups, PAC occurred more frequently than PVC. F actors such as the inserted length of guidewire longer than 20 cm, bon y height less than 170 cm, and female gender were significantly associ ated with GIA (p < 0.005).Conclusions: Limiting the length of the guid ewire insertion to less than or equal to 20 rm for right IJV catheteri zation by using a marked J-wire will reduce the incidence of GIA. We r ecommend the use of a marked J-wire for IJV catheterization.