A NONINVASIVE RETRIEVAL METHOD FOR RETAINED GUIDEWIRE AFTER CENTRAL VENOUS LINE (CVL) PLACEMENT

ABSTRACT

SESSION TITLE Imaging, ECMO, and other Procedures in the ICU Case Posters SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION: Central Venous Catheter placement is a common procedure in the ICU setting and provides a valuable route for medication delivery and venous access. The Seldinger method is the most commonly used method for placement of the catheter, and is the standard of care [1] with current recommendations. However, central line placement is still associated with complications including infection, thrombotic events, and mechanical malfunctions. Guidewire related complications are less common, but can occur [2]. Wire retention is a known, but avoidable complication of central venous catheter placement. Guidewire errors have been associated with operator fatigue, inexperience, and inadequate supervision of trainees. CASE PRESENTATION An immunocompromised 40 year old female who presenting with hypoxia secondary to COVID-19, ultimately requiring intubation. She required initiation of continuous sedatives, analgesics, and vasopressors, for which a CVC was placed. The procedure proceeded in usual fashion with ultrasound and sterilization. Standard seldinger technique with US guidance was utilized. However, during advancement of the catheter, the wire was also advanced and lost within the catheter. DISCUSSION: Using ultrasound the wire could be seen within the lumen of the catheter and approximately 1-2 cm deep. A chest plain film was obtained and displayed above (Figure 1). Given the superficial location of the wire, bedside removal was attempted. Counter-traction was applied anterior to the catheter entry site with a second operator while suction was applied to the terminal catheter port using a 30 cc syringe. A debakey hemostat was utilized to clamp the catheter as it penetrated the dermis. The catheter was removed 2 cm and then the hemostat was released while still applying suction and then again replaced at the same site. This process was repeated three subsequent times and then the catheter was completely removed revealing the guidewire protruding from the initial entry site. The wire was safely removed. The patient was otherwise unharmed and would later discharge to rehab facility. CONCLUSIONS: Central venous catheter placement is a common ICU procedure than can be associated with complications. The above case reflects one complication that occurs per few thousands [3]. Fortunately, bedside retrieval was possible and further invasive procedures were avoided. The above method represents one possible method for removal of a guidewire that is only superficially buried. Finally, this case demonstrates that a thoughtful approach to procedural complications and use of available resources can avoid more invasive procedures, increased risk of further complications, and increased costs to the patient and healthcare system. Reference #1 Thaut L, Weymouth W, Hunsaker B, Reschke D. Evaluation of Central Venous Access with Accelerated Seldinger Technique Versus Modified Seldinger Technique. J Emerg Med. 2019 Jan;56(1)23-28. doi 10.1016/j.jemermed.2018.10.021. Epub 2018 Nov 30. PMID 30503723. Reference #2 Kornbau C, Lee KC, Hughes GD, Firstenberg MS. Central line complications. Int J Crit Illn Inj Sci. 2015;5(3)170-178. doi10.4103/2229-5151.164940 Reference #3 Bessoud B, de Baere T, Kuoch V, Desruennes E, Cosset MF, Lassau N, Roche A. Experience at a single institution with endovascular treatment of mechanical complications caused by implanted central venous access devices in pediatric and adult patients. AJR Am J Roentgenol. 2003 Feb;180(2)527-32. doi 10.2214/ajr.180.2.1800527. PMID 12540466. DISCLOSURES No relevant relationships by John Craver Scientific Medical Advisor relationship with Synspira Please note 3 years Added 03/29/2022 by Bryan Garcia, value=Salary Speaker/Speaker's Bureau relationship with Insmed Please note 3 years Added 03/29/2022 by Bryan Garcia, value=Honoraria Advisory Committee Member relationship with Zambon Pharmaceuticals Please note 2 ears Added 03/29/2022 by Bryan Garcia, value=Honoraria No relevant relationships by John Murphy