• Jung-Man Lee, Jiwon Lee, Jin-Young Hwang, Jee-Eun Chang, Heyrim Kim, Sohee Oh, Eun-Ah Oh, and Seong-Won Min.
• Department of Anesthesiology and Pain medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Sindaebang 2-dong, Dongjak-gu, Seoul 07061, Republic of Korea.
• Am J Emerg Med. 2017 May 1; 35 (5): 743-748.

ObjectiveGuidewire-induced arrhythmias that occur during central venous catheterization can progress to malignant arrhythmias in rare cases. This study compared the incidence of arrhythmia during central venous catheterization using three different depths of guidewire insertion into the right internal jugular vein.MethodsSixty-nine patients undergoing elective surgery requiring central venous catheterization through the right internal jugular vein were enrolled in this double-blind, prospective, randomized, and controlled study. Patients were randomly allocated to receive guidewire insertions to 15cm, 17.5cm, or 20cm before tissue dilation. Arrhythmic episodes were then monitored during dilation of the soft tissue.ResultsA total of 29 patients (42%) experienced arrhythmic episodes during tissue dilation. The guidewire-induced arrhythmia rates of the 15cm group, 17.5cm group, and 20cm group were 0.26 (95% confidence interval [CI]=0.10, 0.48), 0.35 (95% CI=0.16, 0.57), and 0.65 (95% CI=0.43, 0.84), respectively. The incidence of arrhythmic episodes was higher in the 20cm group than in the 15cm (odds ratio [OR]=5.31; 95% CI=1.50, 18.84) and 17.5cm (OR =3.52; 95% CI=1.05, 11.83) groups. There was no significant difference in arrhythmia rates between the 15cm group and 17.5cm group (p=0.542).ConclusionsDuring central venous catheterization through the right internal jugular vein, inserting guidewires to depths of 15 or 17.5cm before tissue dilation reduced the incidence of arrhythmic episodes compared to a depth of 20cm.Copyright © 2017 Elsevier Inc. All rights reserved.

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