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 of guidewire-induced arrhythmia (GIA) during internal jugular venous catheterization (IJV). Design: Prospective study. Setting: Operating rooms at a medical center. Patients: 303 ASA physical status I, II, III, and IV patients undergoing elective surgery. Interventions: All patients were cannulated with the central venous catheters placed via the right internal jugular vein after induction of anesthesia. They were randomly divided 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 length of J-wire inserted was then measured. Measurements and Main Results: Types of arrhythmia [eg, premature atrial contraction (PAC) or premature ventricular contraction (PVC)] were interpreted by attending anesthesiologists 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 < .005). However, in both groups, PAC occurred more frequently than PVC. Factors such as the inserted length of guidewire longer than 20 cm, body height less than 170 cm, and female gender were significantly associated with GIA (p < 0.005). Conclusions: Limiting the length of the guidewire insertion to less than or equal to 20 cm for right IJV catheterization by using a marked J-wire will reduce the incidence of GIA. We recommend the use of a marked J-wire for IJV catheterization.