Q: 58-year-old male with End Stage Renal Disease (ESRD) is admitted to ICU with septic shock. The patient is well known to service as a 'vasculopath' and known to have no upper body vessels available for CVC cannulation. The patient is also known to have IVC filter. Which one trick should be used while placing femoral CVC to minimize the risk of dislodgement of IVC filter?


Answer: Using the non-J tip side of wire to insert CVC line

If a patient is known to have IVC filter, the femoral approach should be avoided as much as possible as guidewire may either displace or get entangle in IVC filter. But in  the situations, where femoral approach becomes the only viable site to insert CVC, the other side of J-wire (non-J side) should be used, as most of the IVC filter displacement, dislodgement or entanglement occurs via J-tip. KUB should be obtained after insertion of CVC to confirm IVC filter's positioning.




References:

1. Wu A, Helo N, Moon E, et al. Strategies for prevention of iatrogenic inferior vena cava filter entrapment and dislodgement during central venous catheter placement. J Vasc Surg 2014; 59:255. 

2. Vinces FY, Robb TV, Alapati K, et al. J-tip spring guidewire entrapment by an inferior vena cava filter. J Am Osteopath Assoc 2004; 104:87.