As a cardiothoracic anesthesiologist and intensivist, my patients have significant comorbidities and have often times had prior instrumentation of their venous systems to place AICD leads, venous stents, temporary pacing wires, etc. This makes it more challenging to place lines that I might need for surgery or with acute decompensation in the ICU. Sometimes, the ‘J’ tip of a traditional central line guidewire meets resistance along indwelling devices. Enter the micropuncture kit!
The kit comes with three pieces: a guidewire, a needle, and an introducer. The benefit of this guidewire is that it has a flexible tip that I can sneak beyond venous narrowing, device leads, etc. Once I’ve accessed the vein with the included needle and successfully passed the guidewire (confirmed with TEE in the OR or with ultrasound in the ICU), I’ll make a small skin nick and pass in the introducer. I’ll then remove the inner stylet and pass my traditional guidewire (for a MAC, Cordis, Trialysis, etc.) to proceed with line placement in the usual fashion.
This technique has saved me a few times and is something I’m going to increasingly start teaching my residents/fellows to have in their arsenal when confronted with difficult line placements.
Drop me a comment below with your questions/experiences regarding the micropuncture kit!