Image intensification - A solution for difficult guidewire insertion for central venous access: A case report

Abstract

Presentation of case: A 56-year old male presented for an elective redo-sternotomy, aortic valve replacement, tricuspid valve annuloplasty, and coronary artery bypass grafting. During central vascular access using a standard Seldinger technique, resistance to two spring-wire guide wires was encountered when the wires were advanced through the patient's internal jugular vein. Ultrasound provided limited views of the anatomical path of the guidewires and was unable to provide visualisation of the level or cause of obstruction. We describe the application of continuous image intensification to successfully identify the anatomical location and safe circumnavigation of guidewire obstruction durin..