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CASE REPORT
Year : 2021  |  Volume : 24  |  Issue : 12  |  Page : 1859-1860

Guidewire lost during endovenous intervention


1 Department of Cardiovascular Surgery, Training and Research Hospital, Ankara, Turkey
2 Department of Cardiovascular Surgery, Ataturk Government Hospital, Düzce, Turkey

Date of Submission11-Jun-2020
Date of Acceptance19-Mar-2021
Date of Web Publication09-Dec-2021

Correspondence Address:
Dr. E Ilkeli
Atatürk Government Hospital, Aziziye Mahallesi, Sht. Ramazan Gel Cd. No: 7, 81010 Düzce
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_349_20

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   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

How to cite this URL:
Duzgun A C, Ilkeli E. Guidewire lost during endovenous intervention. Niger J Clin Pract [serial online] 2021 [cited 2022 Jan 25];24:1859-60. Available from: https://www.njcponline.com/text.asp?2021/24/12/1859/332076




   Introduction Top


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%.[1] In this report, we aimed to present a case of guidewire left unrecognized in the venous system after the CVC procedure.


   Case Report Top


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 Top


CVC is a basic procedure for many intensive care unit. CVC is necessary for hemodynamic monitoring, parenteral nutrition, hemodialysis, medical treatments, and fluid therapy.[2] The most commonly used veins internal jugular veins, femoral and subclavian veins.

CVC complications are mechanical, infectious, and thromboembolic events and forgotten guidewire.[3] 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.[4],[5]

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 Top


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

No.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Feller-kopman D. Ultrasound-guided internal jugular access: A proposed standardized approach and implications for training and practice. Chest 2007;132:302-9.  Back to cited text no. 1
    
2.
Mc Gee DC, Gould MK. Preventing complications of central venous catheterizations. Engl J Med 2003;348:1123-33.  Back to cited text no. 2
    
3.
Blitt CD, Wright WA, Petty WC, Webster TA. Venous catheterization via the external jugular vein. A technique employing the J-WİRE. JAMA 1974;229:817-8.  Back to cited text no. 3
    
4.
Gomez M, Maraqa N, Alvarez A, Rathore M. Complications of outpatient parenteral antibiyotic therapy in childhood. Pediatr Infects Dis J 2001;20:541-3.  Back to cited text no. 4
    
5.
Wu X, Studer W, Skarvan K, Seeberger MD. High incidence of intravenous thrombi after short-term central venous catheterization of internal jugular vein. J Clin Anesth 1999;11:482-5.  Back to cited text no. 5
    


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