Indian Journal of Surgery Medknow Publications on behalf of Association of Surgeons of India ISSN: 0972-2068 Vol. 68, Num. 3, 2006, pp. 171-171

Indian Journal of Surgery, Vol. 68, No. 3, May-June, 2006, pp. 171

Letter To Editor

Lost guide wire during central venous cannulation

Kapadia Sumit

Consultant Vascular Surgeon, Baroda
Correspondence Address:Consultant Vascular Surgeon, Baroda, drsumit_k@rediffmail.com

Code Number: is06050

Related Article: is06007

Sir,

I read with great interest the article on "Lost guide wire during central venous cannulation" by Shishir Kumar et al .[1] Although central venous catheters are an integral part of management of critically ill patients, their use is not without complications.

It is believed that the intravascular insertion of a complete guide wire is a rare, but entirely preventable, complication of central line placement.[2] There have been other previous reports on this unfortunate problem and the following predisposing factors were noticed[2]:

• Inattention
• Inexperience of operator
• Inadequate supervision of trainees
• Overtired staff

Such a lost guide wire can end up traveling in the venous circulation and may even reach to the heart or pulmonary artery in a similar way as catheter fracture and migration. Rarely, it can get embedded in the myocardium, when percutaneous methods of removal may not be successful. Removal via a midline sternotomy and atriotomy has also been published.[3]

It is indeed fortunate that in the authors′patient, the guide wire reached from the internal jugular vein to the inferior vena cava and femoral vein, which is easily accessible surgically. Embolisation of the wire to other areas of the circulation may mandate interventional endovascular techniques or major surgical methods for retrieval.

The following suggestions can be made on basis of personal experience and published literature:

1. Percutaneous Seldinger technique for central venous access is a procedure demanding expertise and careful attention at each step. Proper training and performance under adequate supervision is essential if unforeseen mishaps are to be avoided.
2. The catheter should be passed over the guide wire into the vein while gripping the wire and not pushing catheter and wire together into the vein.
3. Hold onto the distal end of the wire at all times from insertion to removal.
4. Always inspect the wire for complete removal at the end of the procedure.

References

Copyright 2006 - Indian Journal of Surgery