Case report: Managing a knotted Seldinger wire in the subclavian vein during central venous cannulation

Khan, Kamran; Graham, Donald R.; Ermenyi, Agota; Pillay, Woolagasen

doi:10.1007/bf03022660

Cited by 39 publications

(45 citation statements)

References 21 publications

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“…There is a pinch area between the clavicle and the first rib, which impedes anterograde threading of the wire and contributes to looping and knotting. There are several options reported in the literature [1] to deal with the complication of wire knotting, which include withdrawal using radioscopic control through a vessel dilator, especially with large sized loops that tend not to be intraluminal; application of "gentle" or "moderate" traction on the guidewire; and surgical removal in the OR. The first and second options need to be tried using fluoroscopy, which may lead to breaking or intravascular looping of the guidewire [9].…”

Section: Discussionmentioning

confidence: 98%

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The dos and do knots of central venous catheterization

Vetrugno

Piccoli

Costa

et al. 2012

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 98%

“…Knotting of the guidewire is a rare but potential complication of subclavian vein cannulation [1][2][3]. Diagnostic imaging may be of great assistance in monitoring the intravascular or extravascular location of the guidewire.…”

Section: Introductionmentioning

confidence: 99%

The dos and do knots of central venous catheterization

Vetrugno

Piccoli

Costa

et al. 2012

Journal of Clinical Anesthesia

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“…Once a knot is formed, it may be difficult to remove, but must be removed for fear of complications. Khan and coworkers report the use of a track dilator to progressively tighten a knotted subclavian line guidewire in order to remove it [9]. This technique still requires enough exertion of force on the wire to break it in removing it, but the procedure was a success with no sequelae.…”

Section: Technical Aspectsmentioning

confidence: 95%

“…The J-tip wire is formed by flattening the core of the wire approximately 2.5 cm from the tip. While this changes the maneuverability of the wire, it also creates inherent weakness [9]. Most floppy-tip guidewires do not contain the core material at their working end.…”

Section: Tipmentioning

confidence: 99%

Guidewires in clinical practice: applications and troubleshooting

Kipling¹,

Mohammed²,

Medding

2009

Expert Review of Medical Devices

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Guidewires are commonly used in clinical practice over a wide range of specialties. Their use has become more popular as a result of advances in endourology and interventional radiology, as well as in angiographic procedures. While there are many papers regarding individual guidewires and certain technical aspects, for the interested clinician there is little to give a generalized overview within the literature. This paper aims to review guidewires in terms of their make-up, applications and potential complications. Technical points are described, as well as rescue methods for complications, in the hope of preventing future litigation for those reading the paper.

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“…Son yıllarda enfeksiyon komplikasyonları daha çok araştırılmakla birlikte, işlem sırasında karşılaşılan mekanik komplikasyonlar morbidite ve mortalite nedeni olabildikleri için halen önemini korumaktadırlar. SVK yerleştirilmesi sırasında karşılaşılan mekanik komplikasyonlar içinde en sık pnömotoraks bildirilmekle birlikte, yanlış pozisyon, damar yaralanmaları, ritim bozuklukları, kılavuz tel parçasının düğüm olması veya kopması diğer mekanik komplikasyonları oluşturmaktadır (2,3,(5)(6)(7).…”

Section: Introductionunclassified

Serious Complication of Central Venous Catheterization Due to Hemothorax: Hemothorax

Gaygısız¹,

Boyaci²,

Hoşgören³

et al. 2017

tybd

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ÖZ Santral ven kateterizasyonu işlemi hemotoraks ve pnömotoraks ve gibi ciddi komplikasyonlara yol açabilir. Bu olgu sunumunda çoklu travma ve hemotoraks nedeniyle yoğun bakımda izlenen bir hastada subklavian ven kateterizasyonu komplikasyonları olarak; ilk girişimde kılavuz tel ucunun koparak subkutan doku içinde kalması, ikinci girişimde damar içinden damar dışına geçerek hemotoraks içinde sonlanan kateterin neden olduğu hemotoraks sunulmuştur. Kırk yedi yaşında erkek hastada, sol subklavian kateterizasyon için ilk denemede kılavuz telin kolay ilerlemediği görülerek geri çekildi. İkinci kez yeni bir kateterle işlem tekrarlandı ve herhangi bir zorlukla karşılaşılmadan kateter yerleştirildi. Kateter yerinin doğrulanması için kateter içinden alınan örnekte çalışılan kan gazı venöz nitelikteydi. İşlem sonrası hastanın izleminde aynı taraftaki mevcut toraks tüpünden 500 mL hemorajik sıvı geldiği gözlendi. Çekilen kontrol akciğer grafisinde kateterin sol hemitoraks içinde olduğu, ayrıca sol klavikula altında kılavuz tele ait bir parçanın yer aldığı görüldü. Toraks bilgisayarlı tomografisinde kateterin sol subklavian bölgeden sol paramediastinal alana doğru uzandığı belirlendi. Subkutan doku içindeki kılavuz tel parçası ve damar içinden damar dışına geçerek ilerlemiş kateter acil cerrahi girişim uygulanarak çıkarıldı. Santral ven kateterinin ven içinde olduğunu kontrol etmek için yaygın olarak kullanılan yöntem, kolayca enjektöre çekilebilen kanın venöz nitelikte olduğunun belirlenmesidir. Ancak bu yöntem, aynı tarafta daha önceden hemotoraksı olan hastalarda kateterin damar içinde olduğunu kanıtlamakta yetersiz kalmaktadır. Anahtar Kelimeler: Santral venöz kateterizasyon, hemotoraks, travma, komplikasyon ABSTRACT Central venous catheterization may cause life-threatening complications including pneumothorax and hemothorax. We report a case of multiple trauma complicated with an incidence of hemothorax due to a misplaced central venous catheter. Firstly, the tip of the guidewire was ruptured in subcutaneous tissue and, secondly, the catheter came out of the vessel and caused hemothorax. During left subclavian catheterization, in this 47-years-old male patient, we could not advance the guide wire forward easily in the first attempt and tried to draw it back. In the second attempt, we inserted a new catheter without any difficulty. The blood gas analyses through the catheter for verification of location revealed its venous nature. After the catheterization, 500 mL hemorrhagic fluid was drained through the ipsilateral chest tube. Control chest X-ray showed that the catheter was in the left hemithorax and a piece of the guide wire was present below the left clavicle. Thorax computerized tomography showed that the catheter entered the thoracic cavity and extended to the paramediastinal region. An emergency surgery was performed to remove the piece of the guide wire and the catheter extending out of the vessel. A common method to check the intravenous insertion of a central catheter into a vein is to verify that the easily ...

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Case report: Managing a knotted Seldinger wire in the subclavian vein during central venous cannulation

Cited by 39 publications

References 21 publications

The dos and do knots of central venous catheterization

The dos and do knots of central venous catheterization

Guidewires in clinical practice: applications and troubleshooting

Serious Complication of Central Venous Catheterization Due to Hemothorax: Hemothorax

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