Successful removal of kinked J-guide wire under fluoroscopic guidance during central venous catheterization -A case report-

Difficult Internal Jugular Central Venous Cannulation Using J-Tip Guidewire with Indwelling Peripherally Inserted Central Venous Catheters

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.

[Knotted Seldinger wire]

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.

Jugular Venous Catheterization: A Case of Knotting

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.

Diagnosis and Rescue of a Kinked Pulmonary Artery Catheter

Invasive hemodynamic monitoring with a pulmonary catheter has been relatively routine in cardiovascular and complex surgical operations as well as in the management of critical illnesses. However, due to multiple potential complications and its invasive nature, its use has decreased over the years and less invasive methods such as transesophageal echocardiography and hemodynamic sensors have gained widespread favor. Unlike these less invasive forms of hemodynamic monitoring, pulmonary artery catheters require an advanced understanding of cardiopulmonary physiology, anatomy, and the potential for complications in order to properly place, manage, and interpret the device. We describe a case wherein significant resistance was encountered during multiple unsuccessful attempts at removing a patient's catheter secondary to kinking and twisting of the catheter tip. These attempts to remove the catheter serve to demonstrate potential rescue options for such a situation. Ultimately, successful removal of the catheter was accomplished by simultaneous catheter retraction and sheath advancement while gently pulling both objects from the cannulation site. In addition to being skilled in catheter placement, it is imperative that providers comprehend the risks and complications of this invasive monitoring tool.

Percutaneous retrieval of malpositioned, kinked and unraveled guide wire under fluoroscopic guidance during central venous cannulation

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.

Fracture of J-tipped guidewire during central venous catheterization and its successful removal under fluoroscopic guidance -A case report-

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.