A bedside rescue method for retrieving retained guidewires: The ‘Suck Out’ technique

Abstract

Background: Central venous catheter guidewire retention is classed as a ‘never event’ in the United Kingdom, with the potential for significant patient harm. If the retained guidewire remains within the central venous catheter lumen, bedside techniques may facilitate guidewire retrieval. However, these techniques may be ineffective if the guidewire has already passed below skin level. We investigated a novel ‘suck out’ technique for bedside guidewire retrieval and compared this against traditional retrieval methods. Methods: Simulation 1: in a benchtop model, seven different central venous catheters had their corresponding guidewire placed in the last 2 cm of the catheter tip which was immersed horizontally in fluid. A 50-mL syringe was attached to the distal lumen central venous catheter hub and suction applied for 5 s, and the distance of guidewire retraction was recorded. Simulation 2: a central venous catheter guidewire was intentionally retained within the catheter at either 5 cm above or below skin level in a pigskin model. Simple catheter withdrawal, catheter clamping withdrawal and the ‘suck out’ method were compared for efficacy using Fisher’s exact test. Results: Simulation 1: retained guidewires were retracted by 13 cm on average. Simulation 2: when guidewires were retained 5 cm above skin level, all retrieval methods were 100% effective; however, when retained 5 cm below skin level, simple catheter withdrawal was ineffective, clamping and withdrawal was only 10% effective and the ‘suck out’ technique was 90% effective (p < 0.001). Conclusion: The ‘suck out’ technique can effectively retract guidewires retained within central venous catheter lumens and demonstrates superiority over traditional methods of retained guidewire extraction in simulated models.

Identifying a list of healthcare ‘never events’ to effect system change: a systematic review and narrative synthesis

“…We excluded another 337 articles after reviewing the full-text citations largely because they neither identified individual NEs nor specified an existing framework (47%), or because they were non-scholarly (eg, media releases; 30%). Thus, our analyses were based on 367 articles 3 4 7–11 18–377. A full list of these articles and the information we extracted from them are found in online supplemental tables 1 and 2.…”

Central Venous Catheter Guidewire Retention: Lessons From England’s Never Event Database

“…28 Indeed, no single intervention can prevent the entire causal chain of errors that contribute to guidewire retention 5 ; however, a safety-engineered fail-safe will always prompt the clinician to search for the guidewire and thus lead to much earlier recognition when guidewire retention occurs, specifically before the CVC is sutured into place. At this point, bedside retrieval techniques are likely to be more successful, 29 thus avoiding the cost and morbidity associated with more invasive retrieval techniques. Given that guidewire retrieval should occur as a matter of urgency after retention events to prevent wire migration and associated complications, 4,13,14 and 89% of incidents in this data set were only identified after the procedure was complete, the case for earlier identification of these never events is compelling.…”

Retrieval of the lost guidewire immediately after central line insertion by the “clamp technique” – The preponderancy of a procedural checklist and prevention of catastrophe

“…The post-procedure literature review suggested that the suction technique has been described in the bench model of porcine skin for guidewire retrieval. [ 4 ]…”