|Year : 2021 | Volume
| Issue : 12 | Page : 1859-1860
Guidewire lost during endovenous intervention
AC Duzgun1, E Ilkeli2
1 Department of Cardiovascular Surgery, Training and Research Hospital, Ankara, Turkey
2 Department of Cardiovascular Surgery, Ataturk Government Hospital, Düzce, Turkey
|Date of Submission||11-Jun-2020|
|Date of Acceptance||19-Mar-2021|
|Date of Web Publication||09-Dec-2021|
Dr. E Ilkeli
Atatürk Government Hospital, Aziziye Mahallesi, Sht. Ramazan Gel Cd. No: 7, 81010 Düzce
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Central venous catheterization is an important vascular access route used in many operations like open-heart surgery, hemodialysis, multiple trauma patients, total parenteral nutrition, and poor peripheral veins. During central venous catheterization, mechanical complications such as catheter thrombosis, infections, and pneumothorax can develop. In this report, we aimed to present a case of guidewire left unrecognized in venous system after central venous catheterization procedure. The guidewire has been extracted under fluoroscopy guidance. This case emphasizes maintaining and improving patient care and safety by doctor and the team.
Keywords: Central venous catheterization, deep venous thrombosis, guidewire
|How to cite this article:|
Duzgun A C, Ilkeli E. Guidewire lost during endovenous intervention. Niger J Clin Pract 2021;24:1859-60
| Introduction|| |
Central venous catheterization (CVC) is a frequently used invasive vascular access route for many different purposes. Many major surgical procedures such as heart surgery, hemodialysis, multiple trauma patients, total parenteral nutrition, poor peripheral veins preferable CVC.
CVC procedures complications increase in proportion to use. Rate of complications of CVC is about 10–15%. In this report, we aimed to present a case of guidewire left unrecognized in the venous system after the CVC procedure.
| Case Report|| |
A 22-year-old female patient with type 1 diabetes admitted to our emergency service with diabetic ketoacidosis coma 6 months ago. The central femoral vein catheterization was inserted. She was hospitalized due to infection in the left foot. Deep vein thrombosis developed after he was discharged. She was treated with coumadin for 6 months. It was followed by Doppler ultrasonography. He applied to the emergency service with the complaint of wire through from his left foot.” instead of this sentence. On examination, 2-cm guidewire extruding through the lateral edge of her thumbnail bed [Figure 1]. Doppler ultrasonography showed the guidewire in her posterior tibial vein of left leg, the guidewire has been extracted under fluoroscopy guidance.
|Figure 1: Guidewire extruding through the lateral edge of her thumbnail bed|
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| Discussion|| |
CVC is a basic procedure for many intensive care unit. CVC is necessary for hemodynamic monitoring, parenteral nutrition, hemodialysis, medical treatments, and fluid therapy. The most commonly used veins internal jugular veins, femoral and subclavian veins.
CVC complications are mechanical, infectious, and thromboembolic events and forgotten guidewire. Guidewire left in the venous system may cause thromboembolic events, endocarditis, arrythmia and sepsis, which may result in the death of the patient. These complications start to be seen after 3 days so it is important to get the wire out as soon as recognized. Rate of complications related to CVC is about 29% when performed with less trained personnel.,
For this reason, catheterization procedures should be performed in the presence of Doppler ultrasonography. It is very important to avoid complications like this. During the second intervention, the patient should be heparinized. If there is a risk of bleeding, extraction should be tried with a careful surgical approach.
The movement of the guidewire was the opposite direction of the blood because of the gravity. Because we believed that the main cause of this opposite direction of the guidewire was gravity. Physical activities and postures may also cause guidewire coming out of the foot. Nevertheless, valve insufficiency due to deep vein thrombosis may have triggered the movement of the guidewire towards the finger.
| Conclusion|| |
Loss of the guidewire in the blood vessel is a serious problem of CVC. Serious complications include perforation of vascular and cardiac structures. We must make sure that the guidewire does not remain in the blood vessel. In interventional procedures such as central venous catheter placement, the checklist and the doctor's experience are important. The physician should get approval from the patient and the guidewire should be removed before it becomes symptomatic. This case emphasizes maintaining and improving patient care and safety by the doctor and team.
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 initial s 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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