Loss of Guidewire.

Sir,

A male patient suffering from septic shock was referred to the university Intensive Care Unit from another hospital.

Here, a triple-lumen central venous catheter (CVC) was placed, through the right internal jugular vein, using the Seldinger technique. All three ports were aspirated and flushed. The inlying right subclavian CVC was removed. The entire procedure was described as unproblematic, and a bedside chest X-ray was ordered [Figure 1]. Unfortunately, this was misinterpreted.

Figure 1

Guidewire (arrow) on bedside chest X-ray, below level of central venous catheter tip

As no source for the sepsis could be identified, a computed tomography scan was performed the next day. Surprisingly, hyperdense reflexes were observable in the right heart, most likely indicating a retained guidewire that had inadvertently not been pulled out during CVC placement [Figure 2]. Such inattention-related incidences can result in a variety of potentially life-threatening cardiovascular morbidities.[1] Accordingly, such lost guidewires should be removed as quickly as possible.

Figure 2

Guidewire in the right heart (arrows indicate reflexes of guidewire)

Interventional radiology is the recommended method.[2] In this case, the guidewire was caught by a gooseneck snare, passed through the femoral vein using radiographic control, and was removed along with the vascular sheath [Figures 3 and 4].

Figure 3

Aligning of guidewire (arrow)

Figure 4

Gooseneck snare with extracted guidewire

Fortunately, the incidence of lost guidewires is rare; however, in one study, it was calculated to be 0.05%.[3]

TAKE HOME MESSAGES

Not losing guidewires is of the utmost importance

While performing central venous access, always hold onto the wire

If the wire does get lost, it is important to handle the incident appropriately (i.e., identification on chest X-ray and removal by means of interventional radiology).

The patient's wife consented to publication of this letter.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.