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Tal MG, Covey A, Qaqish S, Livne R, Klass D. Prospective evaluation of efficacy and safety of distal radial and radial artery access using a novel articulating-tip guidewire. J Vasc Access 2023:11297298231212227. [PMID: 37997046 DOI: 10.1177/11297298231212227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Guidewire-facilitated access to peripheral vessels is commonplace in vascular access, but guidewire insertion into small vessels, such as the radial and distal radial arteries, can still be challenging. Failure to gain access on the first attempt may contribute to increased risks of procedural complications, such as vessel dissection, spasm, and occlusion. This research assessed the safety and efficacy of radial and distal radial artery access using a novel, FDA-cleared, small-core-diameter guidewire with an articulating tip, under ultrasound guidance. METHODS This was a prospective, single-arm, single-center trial. Patients in need of vascular access were screened for participation and enrolled in the study. Guidewire insertion was attempted by four physicians (three interventional radiologists and an interventional nephrologist) at 162 arterial sites-65 radial and 97 distal radial, having a mean diameter of 2.0 mm. RESULTS First-attempt successful placement of the guidewire in the artery occurred at 87.6% of access sites (142/162) and differences in the success rate between the radial and distal radial arteries or between vessels with diameter smaller or larger than 2 mm were not observed (62/68 and 67/77, respectively; p = 0.6). Four of the five reported adverse events were unrelated to the study device or procedure. Two of the three distal radial artery spasms occurred before the guidewire was used. The other two events were a radial artery spasm, and a distal radial artery site hematoma. All adverse events resolved spontaneously. CONCLUSIONS First-attempt placement of a novel articulating tip guidewire in the radial and distal radial arteries occurred at a high rate in our study and was not associated with safety concerns.
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Affiliation(s)
- Michael G Tal
- Division of Interventional Radiology, Hadassah Medical Center, Jerusalem, Israel
| | - Anne Covey
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ron Livne
- Embrace Medical Ltd., Tel Aviv, Israel
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2
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Patient, Operator, and Procedural Characteristics of Guidewire Retention as a Complication of Vascular Catheter Insertion. Crit Care Explor 2023; 5:e0834. [PMID: 36699255 PMCID: PMC9831189 DOI: 10.1097/cce.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Guidewire retention after intravascular catheter insertion is considered a "never event." Prior reports attribute this complication to various characteristics including uncooperative patients, operator inexperience, off-hour or emergent insertion, and underutilization of ultrasound guidance. In this descriptive analysis of consecutive events, we assessed the frequency of patient, operator, and procedural factors in guidewire retention. DESIGN Pre-specified observational analysis as part of a quality improvement study of consecutive guidewire retention events across a multihospital health system from August 2007 to October 2015. SETTING Ten hospitals within the Cleveland Clinic Health System in Ohio, United States. PATIENTS Consecutive all-comers who experienced guidewire retention after vascular catheter insertion. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data were manually obtained from the electronic medical records and reviewed for potential contributing factors for guidewire retention, stratified into patient, operator, and procedural characteristics. A total of 24 events were identified. Overall, the median age was 74 years, 58% were males, and the median body mass index was 26.5 kg/m2. A total of 12 (50%) individuals were sedated during the procedure. Most incidents (10 [42%]) occurred in internal jugular venous access sites. The majority of cases (13 [54%]) were performed or supervised by an attending. Among all cases, three (12%) were performed by first-year trainees, seven (29%) by residents, three (12%) by fellows, and four (17%) by certified nurse practitioners. Overall, 16 (67%) events occurred during regular working hours (8 amto 5 pm). In total, 22 (92%) guidewires were inserted nonemergently, with two (8%) during a cardiac arrest. Ultrasound guidance was used in all but one case. CONCLUSIONS Guidewire retention can occur even in the presence of optimal patient, operator, and procedural circumstances, highlighting the need for constant awareness of this risk. Efforts to eliminate this important complication will require attention to issues surrounding the technical performance of the procedure.
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Straight-tip guidewire versus J-tip guidewire for central venous catheterisation in neonates and small infants. Eur J Anaesthesiol 2022; 39:656-661. [DOI: 10.1097/eja.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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4
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Hoshi T. Migration of fractured guidewire and its retrieval by endovascular snare catheter: A case report. Radiol Case Rep 2021; 17:481-484. [PMID: 34950278 PMCID: PMC8671804 DOI: 10.1016/j.radcr.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/05/2022] Open
Abstract
Central venous catheterization is commonly used in patients undergoing cardiovascular surgery and it is a relatively safe procedure. A 62-year-old woman who underwent emergency mitral valve replacement for infective endocarditis received a central venous catheter after induction of anesthesia. Postoperative chest radiography revealed a wire-like foreign body near the puncture site of the internal jugular vein, which was later retrieved successfully using a snare catheter under fluoroscopy. This report highlights the importance of careful observation of the withdrawn guidewire and dilator and the role of perivascular ultrasound in all cases requiring this procedure.
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Affiliation(s)
- Takuo Hoshi
- Department of Anesthesiology, Clinical Education and Training Center, University of Tsukuba, Koibuchi 6528, Kasama, Ibaraki, 309-1793 Japan
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5
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Akkuzu E, Sincar Ş, Kalkan G. A Case Series of Life-Threatening Complications of Central Venous Catheter Insertion. Pediatr Emerg Care 2021; 37:e775-e778. [PMID: 34731879 DOI: 10.1097/pec.0000000000002390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Central venous catheters are commonly used in emergency department and the intensive care units for the treatment of critically ill patients. Reports on the rate of mechanical complications of catheter insertion are around 1%. Mechanical complications related with the insertion of the catheter mainly depend on the anatomic location, the use of ultrasound, and experience of the operator. The rate of complication is higher in places where central lines are not routinely inserted as in emergency department. Here, we report a case series of 4 patients who had life-threatening complications of central venous catheter insertion, including venous intimal injury leading to pleural effusion, kinked central venous catheter in the superior vena cava, knotted guidewire with the separation of coil and core, and a missed guidewire with their respective insertion history and imaging. Increasing the awareness of and developing strategies to prevent these rare but potentially fatal conditions may have impact on patient outcomes.
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Affiliation(s)
- Emine Akkuzu
- From the Gazi University Faculty of Medicine, Pediatric Critical Care, Ankara, Turkey
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6
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Langer NH, Hein L, Bestle MH. Intracranial entrapment of a haemodialysis catheter guidewire. BMJ Case Rep 2020; 13:13/8/e232535. [PMID: 32843444 DOI: 10.1136/bcr-2019-232535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old man with chronic obstructive pulmonary disease was hospitalised due to pneumonia and pulmonary embolisms. After subsequently developing septic shock and acute renal failure, he required dialysis. A haemodialysis catheter was planned inserted into the right subclavian vein, the guidewire was introduced using the Seldinger technique. When the guidewire's 20 cm marker entered the introducer needle, it suddenly encountered resistance. Repeated attempts to remove the guidewire failed. Vital signs and haemodynamic parameters remained unchanged throughout the procedure. CT angiography revealed cranial displacement of the wire into the right internal jugular vein, with the tip of the wire just cranial to the jugular foramen in the right sigmoid sinus. Interventional radiological removal attempts were unsuccessful. Thoracic and neurosurgical interventions were considered impossible and the guidewire was left in place. Due to the pulmonary embolism and the foreign object in the patient, life-long anticoagulation was considered, with close monitoring of compliance with the patient's comorbidity and medication.
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Affiliation(s)
- Natasha Hemicke Langer
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark
| | - Lars Hein
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark
| | - Morten Heiberg Bestle
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark.,Department of Clinical Medicine, Nordsjaellands Hospital, University of Copenhagen, Hillerod, Denmark
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Difficult Internal Jugular Central Venous Cannulation Using J-Tip Guidewire with Indwelling Peripherally Inserted Central Venous Catheters. Case Rep Anesthesiol 2019; 2019:5134575. [PMID: 31428478 PMCID: PMC6679875 DOI: 10.1155/2019/5134575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022] Open
Abstract
Central venous cannulation is a commonly performed procedure while managing critically ill patients; increasingly we encounter patients with indwelling wires or devices, like pacemakers, implantable cardioverter defibrillator devices, and peripherally inserted central venous catheters which complicate insertion of central venous catheters further. We present two cases where use of standard J-tip guidewire may have exacerbated the difficulty associated with internal jugular cannulation in presence of peripherally inserted central venous catheters. Recognition and avoidance of possible complications are crucial, and we discuss complexity posed by indwelling peripherally inserted central venous catheters and possible solutions.
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8
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Affiliation(s)
- Komal Anil Gandhi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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9
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Kashif M, Hashmi H, Jadhav P, Khaja M. A Missing Guide Wire After Placement of Peripherally Inserted Central Venous Catheter. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:925-928. [PMID: 27920421 PMCID: PMC5142581 DOI: 10.12659/ajcr.901046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Central venous catheterization is a common tool used in critically ill patients to monitor central venous pressure and administer fluids and medications such as vasopressors. Here we present a case of a missing guide wire after placement of peripherally inserted central catheter (PICC), which was incidentally picked up by bedside ultrasound in the intensive care unit. CASE REPORT A 50-year-old Hispanic male was admitted to the intensive care unit for alcohol intoxication. He was managed for septic shock and required placement of a peripherally inserted central line in his left upper extremity for antibiotics and vasopressor administration. A bedside ultrasound performed by the intensivist to evaluate upper extremity swelling revealed a foreign body in the left arm. Percutaneous procedure by Interventional radiologist was required for retrieval of the guidewire. CONCLUSIONS Guide wire related complications are rarely reported, but are significantly associated with mortality and morbidity. The use of ultrasound guidance placement of PICC lines decreases the risk of complications, provides better optimal vein selection, and enhances success.
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Affiliation(s)
- Muhammad Kashif
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Hafiz Hashmi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Preeti Jadhav
- Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
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Nishant AR, Maddali MM. Structural Defect Leading to an Impression of Iatrogenic Lung Damage. J Cardiothorac Vasc Anesth 2016; 30:e25-6. [PMID: 27039111 DOI: 10.1053/j.jvca.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Arora Ram Nishant
- Department of Cardiac Anesthesia National Heart Center, Royal Hospital Muscat, Oman
| | - Madan Mohan Maddali
- Department of Cardiac Anesthesia National Heart Center, Royal Hospital Muscat, Oman
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11
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Abstract
Background and Aims: Most central venous catheters are placed using Seldinger guide wires. EN ISO 11070 is the guideline for testing guide wire flexing performance and tensile strength, and we can safely assume that guide wires in use meet these requirements. Unfortunately, EN ISO 11070 guidelines do not reflect the clinical requirements and we continue to see mechanical failures and their associated complications. Material and Methods: This in vitro study was performed in an accredited laboratory. With regard to flexing, we: (1) Established the minimum flexing performance needed to meet clinical requirements, (2) developed flexing performance tests which mimic clinical requirement, and (3) evaluated the mechanical properties of various guide wires relative to these requirements. With regard to tensile strength, we used the testing method prescribed in ISO 11070, but did not end the test at 5 Newton (N). We continued until the guide wire was damaged, or we reached maximum tractive force. We then did a wire-to-wire comparison. We examined two basic wire constructions, monofil and core and coil. Results: Tensile strength: All wires tested, except one, met EN ISO 11070 requirements for 5 N tensile strength. The mean of the wire types tested ranged from 15.06 N to 257.76 N. Flexing performance: None of the wires kinked. The monofil had no evidence of bending. Two core/coil wires displayed minor bending (angle 1.5°). All other wires displayed bending angles between 22.5° and 43.0°. Conclusion: We recommend that: (1) Clinicians use guide wires with high-end mechanical properties, (2) EN ISO 11070 incorporate our flexing test into their testing method, raise the flexing requirement to kink-proof, (3) and raise the tensile strength requirement to a minimum of 30 N, and (3) all manufacturers and suppliers be required to display mechanical properties of all guide wire, and guide wire kits sold.
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Affiliation(s)
- Wolfram Schummer
- Department of Anesthesiology, Intensive Care and Emergency Medicine, SRH Clinic Suhl, Suhl, Germany
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12
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Fiala A, Glodny B, Lorenz IH. [Knotted Seldinger wire]. Anaesthesist 2015; 65:42-45. [PMID: 26661081 DOI: 10.1007/s00101-015-0119-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/27/2022]
Abstract
Central venous catheters are usually positioned using the Seldinger technique with a guidewire. This article reports a case where the guidewire was inserted via the left subclavian vein with the landmark technique. The guidewire became kinked, pierced the vessel wall and became stuck forming several loops within the adjacent tissue of the vein. Several attempts were made to remove the guidewire by interventional radiology but were unsuccessful. Due to the critical condition of the patient an operation was considered too perilous and the guidewire was finally left in situ. No formation of local venous thrombosis could be detected.
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Affiliation(s)
- A Fiala
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 36, 6020, Innsbruck, Österreich.
| | - B Glodny
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - I H Lorenz
- Universitätsklinik für Allgemeine und Chirurgische Intensivmedizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
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13
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Jugular Venous Catheterization: A Case of Knotting. Case Rep Med 2015; 2015:810346. [PMID: 26633975 PMCID: PMC4655031 DOI: 10.1155/2015/810346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/29/2015] [Accepted: 10/07/2015] [Indexed: 11/18/2022] Open
Abstract
A 79-year-old woman, diagnosed for cancer of the ovary, had a central catheter that was placed with difficulty through the right internal jugular vein intraoperatively. After oophorectomy, it was realized that the catheter was knotted. Thus, the central venous catheter was removed successfully using a traction technique in the operating room. Central venous catheter use may result in various complications, although it has been used as an invasive method for hemodynamic monitoring and fluid and drug infusion. Here, we present catheter knotting in a case with solutions for this complication, under literature review.
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14
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Abstract
BACKGROUND Almost all central venous catheters are placed using the Seldinger technique. Despite the introduction of ISO 11070 in 1998, we continue to see mechanical wire failures and their associated complications. METHODS Seven different wire types were tested regarding their tensile strength and eight different types for their flexing performance. For each wire type six wires were assessed. Tensile strength was examined using the test method described in ISO 11070, but the test did not end at 10 N. For flexing performance testing a new apparatus, closely mimicking clinical requirements, was designed.Wires were scanned digitally after testing for measurement and analysis. RESULTS All wire types tested, except one, consistently met ISO 11070 requirements for 10 N tensile strength. The maximum tension the wires were able to withstand ranged from 15.06 N to 257.76 N.None of the wires kinked. The monofil wires had no evidence of bending. Two core and coil wires displayed minor bending (angle 1.5°). All other wires displayed bending angles between 22.5° and 43.0°. The degree of bending was also dependent on the angle between the dilator and wire. CONCLUSION The mechanical properties of different types of guidewires show considerable differences, not detected with current ISO 11070 based testing. Uncovering those may allow set up of clinical trials to examine whether regular use of wires with high-end mechanical properties could reduce CVC insertion-related complication rates.
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15
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Jalwal GK, Rajagopalan V, Bindra A, Rath GP, Goyal K, Kumar A, Gamanagatti S. Percutaneous retrieval of malpositioned, kinked and unraveled guide wire under fluoroscopic guidance during central venous cannulation. J Anaesthesiol Clin Pharmacol 2014; 30:267-9. [PMID: 24803771 PMCID: PMC4009653 DOI: 10.4103/0970-9185.130061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The placement of central venous catheter using Seldinger's technique, remains a commonly performed procedure with its own risks and benefits. Various complications have been reported with the use of guide wire as well as catheter. We report a unique problem during subclavian vein cannulation due to guidewire malposition which led to its kinking and difficult retrieval requiring removal in fluoroscopy suit. The probable mechanism of guide wire entrapment and possible bedside management of similar problems is described.
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Affiliation(s)
- Gopal Krishan Jalwal
- Department of Neuroanesthesiology, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vanitha Rajagopalan
- Department of Neuroanesthesiology, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Bindra
- Department of Neuroanesthesiology, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Girija Prasad Rath
- Department of Neuroanesthesiology, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Keshav Goyal
- Department of Neuroanesthesiology, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiology, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiology, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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16
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Srivastav R, Yadav V, Sharma D, Yadav V. Loss of guide wire: a lesson learnt review of literature. J Surg Tech Case Rep 2014; 5:78-81. [PMID: 24741424 PMCID: PMC3977329 DOI: 10.4103/2006-8808.128732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Catheterization of central veins is a routine technique which is widely used in emergency department and medical intensive care units. Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guide wire-related complications are rare but potentially serious. We describe a case of a lost guide wire during central venous catheter (CVC) insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.
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Affiliation(s)
- Rajiv Srivastav
- Department of Cardio Vascular Thoracic Surgery, MGM Medical College, Navi Mumbai, Maharashtra, India
| | - Vishal Yadav
- Department of Surgery, MGM Medical College, Navi Mumbai, Maharashtra, India
| | - Dimpy Sharma
- Department of Surgery, MGM Medical College, Navi Mumbai, Maharashtra, India
| | - Vikas Yadav
- Department of Orthopaedics, Sidharth Hospital, Goregoan, Mumbai, Maharashtra, India
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17
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Williams TL, Bowdle TA, Winters BD, Pavkovic SD, Szekendi MK. Guidewires Unintentionally Retained During Central Venous Catheterization. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.java.2013.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Background: A number of mechanical complications can occur during the insertion of a central venous catheter (CVC), including breakage or loss of the wire and unrecognized failure to remove the wire. Complications related to retention of a guidewire can be serious or fatal.
Methods: Incident reports on retained CVC guidewires entered into the University HealthSystem Consortium (UHC) Safety Intelligence Patient Safety Organization (PSO) database (Chicago, IL) over a 5-year period were reviewed to improve our understanding of their circumstances, causes, and related patient outcomes.
Findings: A total of 42 events that involved retention of a whole guidewire or a fragment of a wire were found in the UHC Safety Intelligence PSO database from 2008 through 2012. Although one-third of these events were discovered during or at the end of the CVC insertion procedure, retained CVC guidewires were commonly discovered days to years after the procedure and on imaging tests performed for unrelated reasons or during other subsequent care. Managers who reviewed the events commonly recommended education and training to prevent retained CVC guidewires, but factors contributing to these events such as distractions and emergency situations also suggest the need for a device design that prevents the occurrence.
Conclusions: Efforts to prevent the loss of CVC guidewires should include clinician education and the development of a device design that prevents inadvertent guidewire loss and alerts clinicians when the end of the guidewire is near.
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Affiliation(s)
| | - T. Andrew Bowdle
- Department of Anesthesiology, University of Washington, Seattle, WA
| | - Bradford D. Winters
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD
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18
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Vertolli U, Davis PA, Calò LA. Fractured catheter guide wire in the right ventricle of a dialysis patient. Nephrology (Carlton) 2013; 19:61-2. [PMID: 24341663 DOI: 10.1111/nep.12154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Ugo Vertolli
- Department of Medicine (DIMED), Nephrology, University of Padova, Padova, Italy
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Ramamoorthy J, Schroder M, Galgon RE. Not so fast! Confusion over a radio-opaque marker. J Clin Anesth 2013; 25:676-8. [PMID: 23994706 DOI: 10.1016/j.jclinane.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/13/2013] [Accepted: 06/18/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Jagan Ramamoorthy
- Department of Anesthesiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53792-3272, USA.
| | - Mark Schroder
- Department of Anesthesiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53792-3272, USA
| | - Richard E Galgon
- Department of Anesthesiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53792-3272, USA
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20
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Yong YP, Abisi S, Whitaker S, Braithwaite B. Technique for retrieval of a knotted and entrapped guide wire after central venous catheterization. Vasc Endovascular Surg 2013; 47:225-7. [PMID: 23404527 DOI: 10.1177/1538574413475886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Central venous catheterization is a common procedure performed in the critically ill patient. The complication associated with this invasive procedure is well established. However, complication related to the guide wire is rare. We present a case of knotted and entrapped guide wire following central venous catheterization using the Seldinger method and technique to retrieve it nonoperatively.
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Affiliation(s)
- Yao Pey Yong
- Department of Vascular and Endovascular Surgery, Nottingham University Hospital, Nottingham NG7 2UH, UK.
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21
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Asayas BCK, John PA, Takroo S. An intra-arterial knotted guide wire. Indian J Surg 2012; 76:331-2. [PMID: 25278662 DOI: 10.1007/s12262-012-0773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 11/20/2012] [Indexed: 11/25/2022] Open
Abstract
Central access is essentially an integral part of critical care, both for invasive monitoring and therapeutic interventions. Seldinger technique is the method for the insertion of a central line. It requires the following steps: cannulation of vessel followed by guide wire insertion, dilation of the tract and the vessel and the insertion and securing of the central line followed its maintenance-each of this step has its own complication.
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Affiliation(s)
- Bosco Chandra Kumar Asayas
- Department of General Surgery, Sri Laksmi Narayana Institute of Medical Sciences, Pondicherry, 605021 India
| | - Prem Anand John
- Department of General Surgery, Sri Laksmi Narayana Institute of Medical Sciences, Pondicherry, 605021 India
| | - Sushrut Takroo
- Department of General Surgery, Sri Laksmi Narayana Institute of Medical Sciences, Pondicherry, 605021 India
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Park SK, Yi IK, Lee JH, Kim DH, Lee SY. Fracture of J-tipped guidewire during central venous catheterization and its successful removal under fluoroscopic guidance -A case report-. Korean J Anesthesiol 2012. [PMID: 23198042 PMCID: PMC3506858 DOI: 10.4097/kjae.2012.63.5.457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Central venous catheterization by Seldinger's technique uses a guidewire which may cause complications such as kinking, knotting and fracture. Fractured guidewire may lead to severe outcomes such as embolization, and removal of it may also cause problems such as vessel damage. We experienced a case of right internal jugular venous catheterization complicated by guidewire fracture entrapped in the central venous catheter, and its successful removal under fluoroscopic guidance using snare-loop. The patient recovered without any complications. When resistance is felt during insertion or withdrawal of the guidewire, force should not be applied to the guidewire and care should also be exercised when passing the tissue dilator over the guidewire. Clinicians should be aware of this rare complication and snare-loop technique could be considered as one of the methods for removal of the fractured guidewire.
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Affiliation(s)
- Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
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Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature. Case Rep Crit Care 2011; 2011:287261. [PMID: 24826318 PMCID: PMC4010052 DOI: 10.1155/2011/287261] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 09/22/2011] [Indexed: 12/30/2022] Open
Abstract
Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guidewire-related complications are rare but potentially serious. We describe a case of a lost guidewire during central venous catheter insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.
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Garg R, Ramaiah VK, Chouhan RS. Damaged guidewire by the introducer needle tip while inserting central venous catheter in subclavian vein by supraclavicular approach. Saudi J Anaesth 2011; 4:210-2. [PMID: 21189864 PMCID: PMC2980673 DOI: 10.4103/1658-354x.71576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rakesh Garg
- Department of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Han HS, Jeon YT, Na HS, Hwang JY, Choi EJ, Kim MH. Successful removal of kinked J-guide wire under fluoroscopic guidance during central venous catheterization -A case report-. Korean J Anesthesiol 2011; 60:362-4. [PMID: 21716566 PMCID: PMC3110296 DOI: 10.4097/kjae.2011.60.5.362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 11/28/2010] [Accepted: 12/15/2010] [Indexed: 11/10/2022] Open
Abstract
Guidewire-associated complications that occur during the process of central venous catheterization include its kinking, looping, knotting and breakage. The removal of a looped or knotted guidewire is problematic because it can cause vessel damage, major hemorrhage, or embolization of a fractured guidewire. We report a case of guidewire kinking and its successful removal under fluoroscopic guidance.
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Affiliation(s)
- Hyun-Seok Han
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Young Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Hyun Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Hariharan U, Sood R, Choudhury A, Garg R, Kaur J. Oxygen desaturation following methylene blue injection: Not always spurious. Saudi J Anaesth 2011; 5:113-4. [PMID: 21655037 PMCID: PMC3101745 DOI: 10.4103/1658-354x.76471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Uma Hariharan
- Department of Anaesthesiology and Intensive Care, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajesh Sood
- Department of Anaesthesiology and Intensive Care, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arindam Choudhury
- Department of Anaesthesiology and Intensive Care, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Rakesh Garg
- Department of Anaesthesiology and Intensive Care, Dr Ram Manohar Lohia Hospital, New Delhi, India
- Address for correspondence: Dr. Rakesh Garg, 58-E, Kavita Colony, Nangloi, Delhi-110041, India. E-mail:
| | - Jaswinder Kaur
- Department of Anaesthesiology and Intensive Care, Dr Ram Manohar Lohia Hospital, New Delhi, India
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Garcia L, Davis J, Davis T, Durrani N, Welliver M. Successive cases of an entrapped arterial catheter guidewire in separate patients on the same day. Can J Anaesth 2010; 57:1131-2. [PMID: 21072623 DOI: 10.1007/s12630-010-9388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 09/07/2010] [Indexed: 11/29/2022] Open
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Onan B, Oz K, Onan IS. Knotted Seldinger guidewire as a complication of Hickman catheter implantation. J Vasc Access 2010; 11:171-2. [PMID: 20175063 DOI: 10.1177/112972981001100218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Khan KZ, Graham D, Ermenyi A, Pillay WR. Case report: managing a knotted Seldinger wire in the subclavian vein during central venous cannulation. Can J Anaesth 2007; 54:375-9. [PMID: 17470889 DOI: 10.1007/bf03022660] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To describe the successful removal of a knotted Seldinger wire from a subclavian vein, and review the design and structure of guidewires to formulate recommendations to minimize complications associated with the Seldinger technique. CLINICAL FEATURES An 81-yr-old patient suffered from an intravascular knotting of a Seldinger wire during subclavian venous cannulation. We describe a technique for successful removal of knotted guidewire under fluoroscopic guidance using the vessel dilator of a central venous cannulation kit. In this case, the technique was successful without associated immediate or delayed complications. Although central venous cannulation with the Seldinger technique is a commonly performed procedure, it may result in numerous complications, including kinking, and rarely complete knotting of the guidewire. CONCLUSIONS A thorough understanding of procedural complications and physical characteristics of the guidewire is vital in order to ensure patient safety when using the Seldinger technique for central venous cannulation. We have reviewed the relevant literature for guidewire design and structure, associated complications, and provide recommendations for safe use of guidewires.
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Affiliation(s)
- Kamran Z Khan
- Nuffield Department of Anesthetics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
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