Broken guide wire - a fault of design?

Abstract

Purpose: To report a potentially serious complication resulting from a faulty guide wire during central venous catheterization. Clinical features:We report breakage of a guide wire with potential severe implications for a 47-yr-old critical care patient. The tip of the J-wire became lodged in the internal jugular vein, and required fluoroscopic guidance for removal, which occurred without complication. Conclusion:Breakage of a guide wire during central venous catheter insertion has been very rarely reported. However, inherent faults in design or in the manufacturing process of the guide wire could lead to this rare complication. A simple bedside test is proposed to detect breakage in the core section of the guide wire. 5% and 19%. 2,3 Catheterization of the superior vena cava is usually carried out using the method described by Seldinger. 4,5 Under certain circumstances, breakage of the guide wire can occur with ensuing risk of foreign body embolism. This complication is extremely rare, with only a few case reports in the literature. 6 Our case demonstrates that guide wire breakage is not necessarily due to handling mistakes, but may also be attributed to inherent design flaws or manufacturing errors. Consent for reporting of personal health information was obtained in accordance with our local institutional guidelines. Objectif Case reportA 47-yr-old male intensive care patient (ASA III, body mass index 21) suffered from an infected large tissue defect on the right lower leg sustained in an accident ten days previously. The past medical history included Crohn's disease which was inactive at that time. His ongoing management required central venous pressure monitoring.A standard single-lumen central venous catheter set was used (Certofix®Mono, 16G, B. Braun, Melsungen, Germany). The enclosed standard steel needle was used for puncture of the right internal jugular vein. Despite free aspiration of blood, the first attempt to insert the J-shaped end of the guide wire failed. A second attempt using the straight end of the guide wire was also unsuccessful. For both attempts, the guide wire could only be advanced a few millimetres beyond the tip of the needle, indicated by a black indicator on the wire. The needle and the guide wire were then removed together, and a second puncture GENERAL ANESTHESIA

Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature

“…Tip breakage of a guidewire has been blamed on inherent design flaws [11]. Shearing and breakage of the wire usually results from pulling the wire back through the needle after it has passed the bevel [7].…”

“…Considering the wire to be a delicate instrument with inherent areas of structural weakness [11]. Thus, on encountering any resistance while advancing or retrieving the wire, force should not be used.…”

An Intra-Arterial Knotted Guide Wire

“…Proper care is mandatory in handling the guide wire for effective use and to prevent complication as described by Monaca et al [3]. A guide wire knot [4] is a rare complication.…”

Successive cases of an entrapped arterial catheter guidewire in separate patients on the same day

“…2 With two consecutive incidences, we suspect a possible guidewire defect and not the technique employed, which was standard in both cases. In a previous report, a case similar to ours was described where the guidewire could not be retracted into the catheter and withdrawal of the whole unit was required.…”