|Year : 2018 | Volume
| Issue : 1 | Page : 58-59
Timely recognition and nonsurgical retrieval of a lost guidewire during central venous catheter placement
Department of Anesthesiology and Critical Care Medicine, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
|Date of Web Publication||10-Sep-2018|
Dr. Anurag Yadava
Department of Anesthesiology and Critical Care Medicine, Bhopal Memorial Hospital and Research Centre, Bhopal - 462 016, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Central venous cannulation is a common procedure used in the intensive care setting. This procedure is known to cause a number of complications, if not carefully performed. We report a case of a lost guidewire during central venous cannulation through the left internal jugular vein approach which was retrieved successfully nonsurgically.
Keywords: Catheterization, central venous catheters, critical illness
|How to cite this article:|
Yadava A. Timely recognition and nonsurgical retrieval of a lost guidewire during central venous catheter placement. J Datta Meghe Inst Med Sci Univ 2018;13:58-9
|How to cite this URL:|
Yadava A. Timely recognition and nonsurgical retrieval of a lost guidewire during central venous catheter placement. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2023 Mar 28];13:58-9. Available from: http://www.journaldmims.com/text.asp?2018/13/1/58/240890
| Introduction|| |
Percutaneous catheterization of central veins is routinely used in critically ill patients. This procedure is known to cause numerous complications. We report an uncommon case of a lost guidewire with its proximal end still near the catheter tip during central venous cannulation which was fortunately diagnosed in time and could be retrieved successfully nonsurgically.
| Case Report|| |
A 40-year-old female patient, an operated case of tricuspid valve repair and atrial septal defect closure, was admitted in the cardiac surgery ward. In the early morning hours on the 3rd postoperative day, a call was sent for the change of the central venous catheter (CVC) to the general intensive care unit as the CVC in situ in the left internal jugular vein seemed to be blocked and the patient was still on inotropic support. The 3rd-year resident attending the call was quite competent and had an experience of putting more than fifty central lines. After confirming the catheter was blocked, the resident decided to insert a new CVC through the same route. Under full aseptic precautions, a new CVC was inserted through the left internal jugular vein by the resident, unsupervised, by exchanging the old catheter with the help of a new guidewire using the Seldinger technique. The whole procedure was carried out smoothly without any complications. At the end of the procedure, when the catheter tray was checked, the guidewire was missing. A thorough search was made for the same, but the guidewire could not be located anywhere. Considering the possibility of a lost guidewire, a chest X-ray was ordered immediately which revealed the guidewire extending well below the inferior vena cava, but fortunately, the proximal end of the guidewire seemed to be still inside the CVC [Figure 1].
|Figure 1: The tip of the central venous catheter (arrow) and the guidewire extending well below inferior vena cava|
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The on-call consultant decided to retrieve the guidewire nonsurgically by a unique technique. Under full aseptic precautions, the CVC catheter was felt for the guidewire and was then firmly grasped by a small artery-holding forceps. The catheter was then pulled out only a few millimeters. The catheter was again checked for the feel of the guidewire, and the procedure was repeated in the same fashion, all the time feeling for the lost guidewire. With just about half centimeters of the CVC remaining, the tip of the guidewire could be felt inside the CVC and it was carefully extracted in toto. Complete removal of the guidewire was confirmed with a repeat chest X-ray. When examined, the guidewire was intact, and the whole procedure went smoothly without any arrhythmias or any untoward hemodynamic event. During further discussions, the ICU resident and the assisting staff revealed the probable cause of this preventable mishap. The resident who performed the procedure was extremely busy that day. Even during the procedure, his cell phone rang multiple times. The resulting distraction seems to be the possible cause of this mishap.
| Discussion|| |
Placement of a CVC requires meticulous attention. We present a case of a “forgotten guidewire” in a postoperative cardiac patient. The attending senior resident had enough experience in placing CVC in such patients. However, as the procedure took place in the early morning hours, it is quite possible that fatigue played a role. In addition, distraction by the repeated phone calls may be another important factor in the development of this complication. The published literature on the complications of lost guidewire is limited. Usually, the loss of a complete guidewire passes uncomplicated, but such a foreign body can cause a number of complications including vascular damage, thrombosis, arrhythmias, arterial puncture, cardiac tamponade, and embolism.
Fortunately, our patient did not experience any such complications. The intravascular loss of a guidewire must be immediately recognized at the time of the procedure and should be removed as quickly and completely as possible. A chest X-ray after the procedure should be essential following cannulation of internal jugular or subclavian vein. Expert operator skills and compliance with the catheterization protocol are mandatory to prevent this complication. Such protocols may include firmly holding to the tip of the guidewire all the time during catheter insertion and counting needles and wires in the catheter tray at the end of the procedure. To prevent CVC guidewire loss, especially for the inexperienced, unsupervised operators, and in emergency situations, a small artery forceps can be used to fix the non “J” end of guidewire during dilator use and while sliding CVC into the vein. Before the procedure, the operator must give his pager/cell phone to an individual not involved with the procedure to avoid any distractions. At the end of the procedure, a “time-out” should be instituted during which the operator calls out loudly and clearly that “the guidewire is out of the patient” and this is confirmed by the bedside nurse.
| Conclusion|| |
Loss of the guidewire is a rare, relatively dangerous, and preventable complication. Predisposing factors include operator inexperience, inattention, and fatigued medical staff. Given the dangers of adverse consequences, we can help prevent guidewire loss by educating staff and meticulously following standard operating procedures.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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