An unexpected image on a chest radiograph.

Introduction Central venous catheterisation is an essential component of patient care in hospital. A forgotten complete guide-wire is a rare complication, although the reported incidence has increased rapidly over the last decade. Case report We report a 72-year-old man with a complete guide-wire inadvertently overlooked during catheter insertion. A central venous catheter had been inserted for total parental nutrition during treatment for pancreatitis. Five years later, the patient was readmitted with a painful lesion on his neck and the sensation of a sharp object under his skin. He was discharged without complication following removal of the free part of the guide-wire that had not become attached to the endothelial layer. Conclusion Inattention, inexperience and lack of supervision by a more experienced clinician are considered the most important contributing factors to this complication. Ultrasonography assistance during the procedure, senior supervision, a set count and a chest X-ray after the procedure are recommended in order to prevent forgotten guide-wires.

Efficacy and safety of bone wax to reduce sternal bleeding following coronary bypass surgery.

OBJECTIVE: To elucidate the effect of bone wax on postoperative bleeding, infection and wound healing. METHODS: This study included two independent groups, consisting of 94 patients who were treated with bone wax and 90 patients who received nothing after median sternotomy and just before sternal closure. Demographic and postoperative data were recorded. Both groups were compared with respect to the amount of postoperative drainage, blood transfusion requirement, re-exploration because of bleeding, and mortality rates. RESULTS: Demographic measurements did not differ between the groups. In the first two months of the postoperative period, mediastinitis was not seen in any of the patients in both groups. Superficial wound infection was detected in six patients (6.4%) in Group A. Eight patients (8.9%) suffered from superficial wound infection in Group B (p >0.05). In the first postoperative 24 hours, the average amount of postoperative drainage was 536.89 ml in Group A, whereas it was 529.67 ml in Group B (p >0.05). Three patients in both groups died in the early phase of the postoperative period (p >0.05).There was not any statistically significant difference between groups considering bleeding quantity, mortality, re-exploration, amount of blood used and deep sternal infection. CONCLUSION: Bone wax does not reduce bleeding on sternal sides. No evidence was found that application of bone wax causes deep sternal infection in patients having median sternotomy for coronary bypass surgery.