Central Line Guidewire Confirmation With TEE

Whenever my residents/fellows or I place central venous catheters (CVCs) in the operating room in a case where we’ll be performing intraoperative transesophageal echocardiography (TEE), I always place the TEE probe beforehand. I obtain a midesophageal bicaval view looking for preexisting hardware in the patient’s right atrium (RA) such as ICD wires, PICC lines, etc.

The overwhelming majority of the central lines I place are in the right jugular vein or left subclavian vein. Subclavian CVCs are typically placed with a landmark technique and confirmed with manometry. Linear ultrasound probes facilitate the placement of internal jugular CVCs. In either case, I try to see the Seldinger guidewire in the right atrium prior to dilation and catheter placement.

Midesophageal bicaval TEE view – left atrium (LA), interatrial septum (IAS), right atrium (RA), superior vena cava (SVC), Seldinger guidewire (“guidewire”) passed into RA via the right internal jugular vein

In the video above, I noted an existing line in the right atrium (RA). You can see the Seldinger guidewire enter the RA from the superior vena cava (SVC) during right internal jugular (IJ) vein CVC placement. This is an additional means of confirming that the wire is indeed in the venous system and not in the carotid artery.

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