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LETTER TO EDITOR
Year : 2010  |  Volume : 54  |  Issue : 4  |  Page : 354-355 Table of Contents     

Entrapped central venous catheter guide wire


Department of Anesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal - 462 038, India

Date of Web Publication12-Aug-2010

Correspondence Address:
Sarika Katiyar
B-10, Bhopal Memorial Hospital and Research Center, Bhopal - 462 038
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.68378

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How to cite this article:
Katiyar S, Jain RK. Entrapped central venous catheter guide wire. Indian J Anaesth 2010;54:354-5

How to cite this URL:
Katiyar S, Jain RK. Entrapped central venous catheter guide wire. Indian J Anaesth [serial online] 2010 [cited 2019 Jun 17];54:354-5. Available from: http://www.ijaweb.org/text.asp?2010/54/4/354/68378

Sir,

The use of central venous catheterisation is common in the setting of ICU for monitoring of CVP, fluid administration and drug infusions. In our unit by current estimates, 1,700 catheters are inserted per year. However, placement of CVCs is not innocuous. Numerous complications may occur, with varying frequency and severity. Acute complications like: arrhythmias, arterial puncture, pneumothorax, etc., are readily apparent. Rarer complications such as those involving guide wire insertion or removal often are not readily apparent. Most common complication of the passage of a guide wire is the induction of cardiac arrhythmias. Other complications include: looping, knotting, vascular perforation, fragmentation and embolisation, entrapment of the wire in the IVC filter and the Sternocleidomastoid muscle. We describe the entrapment of guide wire probably in the subcutaneous tissue.

A 35-year-old female presented in emergency with tachypnoea and hypotension. She was a known case of Chronic Renal Failure since five years and was on regular dialysis. On ABG analysis: her PO 2 was 68 mm Hg, pH-7.36, pCO 2 -21mm Hg SpO 2 was 89%. Her USG was done which revealed bilateral pleural effusion. Other physical examination findings were within normal limit.

She was shifted to ICU for further management and dialysis. She was put on noninvasive ventilation which she tolerated well. In view of haemodynamic instability central venous cannulation was planned. After ensuring appropriate coagulation status, right-sided internal jugular vein was chosen for cannulation. A seven French percutaneous Seldinger type 15 cms length catheter was used. Under all aseptic precautions right internal jugular vein was cannulated with 24-gauge needle followed by introducer needle which punctured the vein on first attempt.

After aspiration of blood, guide wire was introduced, but it could not be introduced more than five centimeters. Thus, we tried to remove the guide wire, to reconfirm the backflow of blood in the introducer needle. But guide wire was stuck and many attempts to remove it with gentle traction failed. During this traction the introducer needle slipped and only the guide wire was left in place. We got a portable Chest X-ray done, which revealed that only J-tip of guide wire was stuck. Thus, after excluding guide wire knotting removal of guide wire was attempted again and it came out with gentle traction [Figure 1]. After removal of guide wire local pressure was applied. USG was done to reveal any injury or local haematoma. Gradually, patient improved and was shifted to ward.
Figure 1: Tip of the CVC guide wire after removal

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Central Venous Catheterisation placement is an extremely common procedure performed at virtually every institution by a variety of specialists. Central Venous Catheterisation is traditionally done blindly by skin landmarks. However, National Institute for Clinical Excellence (NICE) has published its recommendations for use of ultrasound locating devices for placing central venous catheters. Ultrasound reduces the incidence of complications related to venous puncture. [1,2] Complications can still occur after the safe venous puncture including, the guide wire, the dilator or the catheter insertion complication.

Catheter related complications are well known, but there are very few reports in which guide wire has been involved. Most common guide wire related complications include entrapment of guide wire in the Sternocleidomastoid muscle and Inferior Venacava Filters. [3],[4],[5] Most of the reports published mentions initial difficulty with the passage of guide wire. Any resistance felt during guide wire insertion should prompt needle withdrawal several millimeters. If the guide wire cannot be passed easily without resistance, procedure should be stopped; needle and guide wire should be removed as a single unit and pressure applied. In our case the needle was withdrawn and guide wire pulled thereafter. Probably, the J-tip of guide wire got stuck just underneath the skin. Luckily, in this case guide wire could be easily removed in few attempts of gentle traction; otherwise it would have required surgical exploration.

Here we want to emphasize that even though central venous catheter placement is common, execution of details is imperative. We should be aware of potential entrapment of guide wire during central venous catheterisation. CVCs often are placed by personnel who are in training; closer supervision by more senior person may help identify and prevent similar complications. It is also important that force should never be used to withdraw a guide wire when unexpected resistance is encountered, as this may result in fracture of the wire and damage to the internal structures.

 
   References Top

1.Scott DH. Editorial II. The king of the blind extends his frontiers. Br J Anaesth 2004;93:175-7.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Guidance on the use of ultrasound locating devices for placing central venous catheters. Technology Applied Guidance No. 4; Sept. 2002. National institute for clinical excellence. Available from: http://www.nice.org.uk [last cited on 2010 May 20].  Back to cited text no. 2      
3.Mastan M, Clothier PR, Ousta B, Deulkar U. Internal jugular venous cannulation complicated by J-tip guide wire entrapment. Br J Anaesth 2001;86:292-3.  Back to cited text no. 3  [PUBMED]    
4.Polos PG, Sahn SA. Complications of CVC insertion-fragmentation of a guide wire with pulmonary artery embolism. Crit Care Med 1991;19:438-40.  Back to cited text no. 4  [PUBMED]    
5.Andrews RT, Geschwind JF, Savader SJ, Venbrux AC. Entrapment of J-tip guide wires by venatech and stainless steel Greenfield Venacava filters during central venous catheter placement. Percutaneous management in four patients. Cardiovasc Intervent Radiol 1998;21;424-8.  Back to cited text no. 5      


    Figures

  [Figure 1]


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