Unusual but completely avoidable complication during central venous catheterization

Abstract

Central venous catheterization is generally a safe procedure, but several complications such as pneumothorax, arrhythmias, arterial puncture, infection, and thrombosis are known to occur even in the experienced hands. Complications related to guide wire are very rare and mostly relate to the expertise of operating person. We hereby report a rare but completely avoidable complication, that is, complete loss of the guide wire into the subclavian vein which was successfully retrieved by surgery.

Loss of guide-wire during central venous cannulation – Life long learning!

“…Extraction by surgical exploration has also been reported if percutaneous methods fail. [ 5 ] To prevent intravascular loss of guide-wire, following precautions must be considered- a) hold the proximal tip of the guide-wire at all times b) avoid excessive insertion of the guide-wire (maximum 18 cm from puncture sites) c) using the Seldinger technique, the wire must be visible at the proximal end before railroading the catheter d) after catheter insertion, the immediate step should be removal of the guide-wire e) after catheterization, always inspect the procedural tray for complete wire removal and get the chest X ray.…”