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Hobbs KJ, Young KAS, Nannarone S, Luethy D, Hopster‐Iversen C, McKenzie HC, Ludwig EK. Intravenous loss of over-the-wire catheter guidewires in 13 horses. J Vet Intern Med 2024; 38:411-416. [PMID: 38095356 PMCID: PMC10800200 DOI: 10.1111/jvim.16960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Over-the-wire (OTW) catheter placement is performed frequently in horses. Intravascular loss of a guidewire has been anecdotally reported, but there is limited information regarding the treatment and outcome of horses that have experienced this complication of OTW catheter placement. OBJECTIVES Describe the clinical and diagnostic features, treatment, and outcome of horses experiencing IV guidewire loss at the time of OTW catheter placement. ANIMALS Thirteen horses. METHODS Multicenter retrospective study to identify horses with IV guidewire loss. Horses of all ages were considered for inclusion. Horses were excluded from the study if complete medical records of signalment, indication, and outcome were not available. Intravenous guidewire loss was defined as the guidewire being lost IV at the time of OTW catheter placement. RESULTS No horses in this study experienced adverse clinical signs associated with the loss of a guidewire. Eight horses had the guidewire removed and the guidewire was left in situ in 5 horses. None of the horses with the guidewire in situ had experienced long-term effects. CONCLUSIONS AND CLINICAL IMPORTANCE Intravenous guidewire loss seems to have a good long-term prognosis even in horses in which removal of the guidewire was not possible. Thus, in horses where guidewire removal is not feasible, guidewires that remain in situ may have limited to no adverse effects.
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Affiliation(s)
- Kallie J. Hobbs
- Department of Large Animal Clinical SciencesNorth Carolina State University College of Veterinary MedicineRaleighNorth CarolinaUSA
| | - Kimberly A. S. Young
- Department of Large Animal Clinical SciencesNorth Carolina State University College of Veterinary MedicineRaleighNorth CarolinaUSA
| | - Sara Nannarone
- Department of Veterinary MedicineUniversity of PerugiaPerugiaItaly
| | - Daniela Luethy
- Department of Large Animal Clinical SciencesUniversity of Florida College of Veterinary MedicineGainesvilleFloridaUSA
| | - Charlotte Hopster‐Iversen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenTaastrupDenmark
| | - Harold C. McKenzie
- Department of Large Animal Clinical SciencesVirginia Maryland College of Veterinary MedicineBlacksburgVirginiaUSA
| | - Elsa K. Ludwig
- Department of Large Animal Clinical SciencesNorth Carolina State University College of Veterinary MedicineRaleighNorth CarolinaUSA
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Amini AA, Alzuabi A, Baniyassen M, Gharbi M, Aziz MA, Abbas MM. A 47-Year-Old Woman with a Retained Central Venous Catheter Line Guidewire Presenting with a Right Atrial Thrombus Requiring Removal During Open Heart Surgery: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e939908. [PMID: 37700515 PMCID: PMC10505040 DOI: 10.12659/ajcr.939908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/02/2023] [Accepted: 07/25/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND A central venous catheter (CVC) is an indwelling catheter that is inserted into a large central vein for different purposes, including hemodynamic monitoring and administration of fluids and medications. This report is of a 47-year-old woman with a retained CVC line guidewire presenting with a large right atrial thrombus requiring removal during open heart surgery. CVC insertion is one of the most frequently attempted procedures in intensive care units, emergency departments, and operation rooms, especially for critically ill patients. Possible complications range from failure to place the catheter to cardiac arrest. One of the rarest complications is missing the guidewire after insertion, which is usually discovered early after inserting it. CASE REPORT We report the case of a 47-year-old woman who had a CVC line inserted following complicated open cholecystectomy. A few years later, she developed shortness of breath, with an incidental finding of a huge right atrial thrombus and a wire shown on transthoracic echocardiography. The right atrial thrombus required open heart surgery to excise the thrombus and the wire, which was done successfully. The thrombus was histopathologically and clinically proven to be an organized right atrial thrombus formed around the CVC guidewire. CONCLUSIONS This case report presents a rare complication of CVC insertion. Because this procedure is increasingly used, clinicians should be aware of the potential complications of retained CVC lines. Moreover, this report outlines different techniques to prevent such fatal complications and emphasizes the significance of radiography after insertion.
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Affiliation(s)
- Ahmad Alsaka Amini
- Department of Anesthesia and Critical Care, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Abeer Alzuabi
- Department of Anesthesia and Critical Care, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Mohannad Baniyassen
- Department of Anesthesia and Critical Care, Sharjah Kuwait Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Maro Gharbi
- Department of Anesthesia and Critical Care, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Mohamed Abdel Aziz
- Department of Cardiac Surgery, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Mohamed Magdy Abbas
- Department of Cardiac Electrophysiology, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
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van den Bogert PC, de Araujo WJB, Ruggeri VGM, Caron FC, Erzinger FL, de Macedo PEM. Accidental guide wire migration and late percutaneous externalization after central venous catheterization. J Vasc Access 2023; 24:824-827. [PMID: 34711084 DOI: 10.1177/11297298211054898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 70-year-old man was admitted to the emergency department with recent spontaneous externalization of a metallic device from his right inner thigh. He had been experiencing mild local pain for 2 weeks and had a recent hospitalization due to cardiogenic hemodynamic instability, requiring a central venous catheter placement in his right internal jugular vein 3 months earlier. Doppler ultrasound confirmed the intravascular foreign body hypothesis as a guidewire was identified inside the right femoral vein, associated with femoropopliteal venous thrombosis. The guidewire was successfully removed percutaneously through simple manual traction guided by radioscopy. The patient was discharged the following day on oral anticoagulation with rivaroxaban. On outpatient follow-up 4 weeks post discharge, he had no complaints in the right lower limb except for slight swelling. Central venous catheterization is a common invasive procedure that, although unquestionably safe and well stablished in medical practice, can lead to serious complications when performed without proper technique.
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Affiliation(s)
- Petra Cristina van den Bogert
- Hospital Angelina Caron, Campina Grande do Sul, Paraná, Brazil
- Circulation Institute-Excellence in Angiology, Vascular and Endovascular Surgery, Curitiba, Paraná, Brazil
| | - Walter Junior Boim de Araujo
- Hospital Angelina Caron, Campina Grande do Sul, Paraná, Brazil
- Circulation Institute-Excellence in Angiology, Vascular and Endovascular Surgery, Curitiba, Paraná, Brazil
| | - Viviane Gomes Milgioransa Ruggeri
- Hospital Angelina Caron, Campina Grande do Sul, Paraná, Brazil
- Circulation Institute-Excellence in Angiology, Vascular and Endovascular Surgery, Curitiba, Paraná, Brazil
| | - Filipe Carlos Caron
- Hospital Angelina Caron, Campina Grande do Sul, Paraná, Brazil
- Circulation Institute-Excellence in Angiology, Vascular and Endovascular Surgery, Curitiba, Paraná, Brazil
| | - Fabiano Luiz Erzinger
- Hospital Angelina Caron, Campina Grande do Sul, Paraná, Brazil
- Circulation Institute-Excellence in Angiology, Vascular and Endovascular Surgery, Curitiba, Paraná, Brazil
| | - Paulo Eduardo Muller de Macedo
- Hospital Angelina Caron, Campina Grande do Sul, Paraná, Brazil
- Circulation Institute-Excellence in Angiology, Vascular and Endovascular Surgery, Curitiba, Paraná, Brazil
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Eskandarian R, Abdollahpour A, Aghaamoo S, Amini N, Zangian H, Ghods K. A Case Report: Surgical Removal of Missing Guide Wire, Is it the Best Intervention? Bull Emerg Trauma 2022; 10:138-140. [PMID: 35991371 PMCID: PMC9373055 DOI: 10.30476/beat.2021.90494.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/20/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022] Open
Abstract
Nowadays, the use of central venous catheter insertion (CVC), has abundantly increased. It is a common technique in critically ill patients who are admitted to intensive care and emergency departments in order to hemodynamic monitoring and fluid and medication administration. In this report, we express a 28-year-old man who has multiple trauma with decreased level of consciousness during a car accident three months ago and needs intensive care and monitoring by central venous catheter placing. A missed guide wire remaining inside the venous system after peripherally inserted in femoral vein that was incidentally diagnosed by taking a chest X-ray after three months. Although, guide wires are often retrieved by snaring catheter under fluoroscopic guidance and an interventional cardiologist, we have successfully extracted the lost wire through vascular surgery. Eventually, this report is supposed to increase awareness of this rare and preventable complication and to provide a solution to prevent this complication. Finally, the purpose of this report is to emphasize that surgical extracting is the best intervention to remove the missed guide wire (after 3 months) and this option could be developed, introduced and standardized in appropriate and controlled conditions.
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Affiliation(s)
- Rahimeh Eskandarian
- Interventional Cardiologist, Semnan University of Medical Sciences, Semnan, Iran
| | - Abolfazl Abdollahpour
- Department of Anesthesiology, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Shahrzad Aghaamoo
- Department of Obstetrics and Gynecology, Semnan University of Medical Sciences, Semnan, Iran
| | - Narges Amini
- Department of Cardiac Surgery, Semnan University of Medical Sciences, Semnan, Iran
| | - Hoda Zangian
- Department of Cardiac Anesthesiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Kamran Ghods
- Cardiac Surgeon, Semnan University of Medical Sciences, Semnan, Iran,Corresponding author: Kamran Ghods, Address: Cardiac Surgeon, Associate Professor, Semnan University of Medical Sciences, Semnan, Iran. Tel: +98-23-33451336, e-mail:
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Lai F, Xie D, Weng Y, Mai S, Du J, Han Y, Zhang Y. Application of plan-do-check-act management to improve first-attempt insertion success rates of internal jugular vein catheterization for standardized training residents in an intensive care unit. BMC MEDICAL EDUCATION 2022; 22:420. [PMID: 35655205 PMCID: PMC9161493 DOI: 10.1186/s12909-022-03418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the intensive care unit (ICU), internal jugular vein puncture and catheterization are basic rescue operations that physicians need to complete quickly and independently. It is necessary to improve the first-attempt success rate of internal jugular vein catheterization, shorten the catheterization duration and reduce the incidence of complications for standardized training residents (STRs). OBJECTIVE To improve first-attempt insertion success rates of internal jugular vein catheterization for STRs. METHODS Based on the PDCA cycle management method and current situation investigation, the PDCA management objectives were set, and the implementation content, monitoring items and continuous improvement plan were formulated. The data of residents who were trained in the ICU of Fangcun Hospital, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, from January 2016 to April 2016 and managed by the PDCA cycle (PDCA group), were compared with the data of residents trained in the same department from August 2015 to November 2015 before the implementation of PDCA (historic control group), the first-attempt success rate of puncture and catheterization, the duration of puncture and catheterization, and the incidence of complications were analysed. RESULTS Thirty-six cases of internal jugular vein catheterization were performed by the PDCA group, 21 cases (58%) were performed by residents in the third year of standardized training, and 15 cases (42%) were performed by residents in the second year of standardized training. Compared with the historic control group, there was no significant difference in the seniority of residents (X2 = 0.240, P = 0.625) or the 'majors of the residents (X2 = 1.306, P = 0.835). The first-attempt success rate of puncture in the PDCA group was 94% (34/36), which was significantly higher than that of the historic control group (55% (11/20) (P = 0.001). In the PDCA group, the first-attempt success rate of puncture among third-year standardized training residents was 95% (20/21), and the first-attempt success rate in the second-year was 93% (14/15), which were significantly higher than the corresponding rates of 62% (8/13) and 43% (3/7) respectively, in the historic control group (all P = 0.021). The duration of catheterization was [4 (3,5)] min after PDCA, which was significantly shorter than that in the historic control group [9 (6.25,13.00)] min (Z = - 5.214, P < 0.001). The incidence rate of complications in the PDCA group was 0% (0 /36), which was significantly lower than the rate of 20% (4 / 20) in the historic control group (P < 0.013). CONCLUSION PDCA cycle management can help improve the first-attempt success rate of internal jugular vein puncture and catheterization, shorten the duration of puncture and catheterization, and reduce the incidence of complications. The idea and method of PDCA cycle management can be applied to other training and management protocols for STRs.
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Affiliation(s)
- Fang Lai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Dongping Xie
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Yanna Weng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Shutao Mai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Jiongdong Du
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Yun Han
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Yan Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China.
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Delayed diagnosis of a retained guidewire after bedside femoral venous catheter insertion: A preventable complication. Radiol Case Rep 2022; 17:647-649. [PMID: 35027989 PMCID: PMC8715130 DOI: 10.1016/j.radcr.2021.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
Central venous catheter (CVC) insertion is a commonly performed procedure that is used for continuous invasive hemodynamic monitoring, fluid resuscitation, drug therapy, and hemodialysis. CVC placement can be associated with serious complications that are mostly preventable. One of these complications is the loss of the guidewire within the intravascular space, which carries a high morbidity and mortality. Here, we describe a 44-year old patient who presented with acute kidney injury and metabolic derangements that necessitated bedside right femoral dialysis catheter to initiate emergent renal replacement therapy. A day after the catheter insertion, the guidewire was noted on a routine chest X-ray extending into the base of the skull. The clinical course was complicated with cerebral infarction. Subsequently, the retained guidewire was removed a few days after the CVC insertion. In summary, the retained guidewire within the circulation is associated with potentially life-threatening and hazardous outcomes. Continuing education, vigilant supervision, and implementing certain protocols are likely to prevent such undesirable events.
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Abstract
We report a pediatric patient who underwent a central venous catheter (CVC) insertion and presented with a sudden protrusion of a guidewire from the neck 26 months later. The guidewire was extracted via femoral venotomy. A 5-cm portion of the guidewire adhering to the superior vena cava wall was left in place. We recommend always using a CVC checklist, inspecting the guidewire before and after insertion, and carefully examining the postinsertion radiographs. This checklist should be mandatory with every CVC insertion, including the perioperative period.
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Lahiri R, Darbari A. Guidewire complications during central vein cannulation: A peril underestimated. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_48_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dubey P, Rahul R, Bharti A. Yet another lost guide wire. Saudi J Anaesth 2020; 14:554-556. [PMID: 33447212 PMCID: PMC7796729 DOI: 10.4103/sja.sja_108_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 11/04/2022] Open
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