Supraclavicular coronal oblique plane view and rainbow sign: A novel ultrasound technique for real-time detection and correction of guidewire misplacement during subclavian vein catheterization.

BACKGROUND: Guidewire misplacement into the ipsilateral internal jugular vein is a recognized complication of subclavian vein catheterization. Current methods can identify the misplacement but typically provide only post-procedural verification, precluding intra-procedural correction. We aimed to describe and evaluate a novel ultrasound-guided technique for real-time detection and redirection of misplaced guidewires during subclavian vein catheterization. METHODS: This prospective observational study enrolled patients undergoing elective gastrointestinal tumor surgery who required ultrasound-guided right subclavian vein catheterization at a tertiary hospital between March and August 2023. When guidewire misplacement was detected, a standardized correction technique was applied, which included the supraclavicular coronal oblique plane view for visualizing the internal jugular vein, subclavian vein, and brachiocephalic vein confluence, a guidewire manipulation maneuver for redirection, and the "rainbow sign"-a reverberation artifact confirming correct guidewire direction. The incidence of guidewire misplacement, success of redirection, and procedure-related complications were recorded. RESULTS: Of 93 cases enrolled, guidewire misplacement into the ipsilateral internal jugular vein occurred in 10 patients (10.8%), and misplacement into the contralateral brachiocephalic vein occurred in one patient (1.1%). All 11 misplaced guidewires were successfully redirected into the correct position using the ultrasound-guided technique described above, achieving a 100% success rate. No complications related to the redirection maneuver were observed, including no vascular injury, sustained arrhythmia, or guidewire kinking. CONCLUSIONS: The supraclavicular coronal oblique plane view and "rainbow sign" provide a practical approach for real-time detection and correction of guidewire misplacement during subclavian vein catheterization. Further validation in larger, multicenter cohorts is warranted.