Fracture of J-tipped guidewire during central venous catheterization and its successful removal under fluoroscopic guidance -A case report-

Abstract

Central venous catheterization by Seldinger's technique uses a guidewire which may cause complications such as kinking, knotting and fracture. Fractured guidewire may lead to severe outcomes such as embolization, and removal of it may also cause problems such as vessel damage. We experienced a case of right internal jugular venous catheterization complicated by guidewire fracture entrapped in the central venous catheter, and its successful removal under fluoroscopic guidance using snare-loop. The patient recovered without any complications. When resistance is felt during insertion or withdrawal of the guidewire, force should not be applied to the guidewire and care should also be exercised when passing the tissue dilator over the guidewire. Clinicians should be aware of this rare complication and snare-loop technique could be considered as one of the methods for removal of the fractured guidewire.

Guidewire fragmentation complicating hemodialysis catheter insertion

“…Though previous reports of the guide wire fracture have been attributed to faulty design (material weakness or fatigue)[ 1 ] or introducer needle injury,[ 2 ] in our case the two previous attempts of passing the guide wire may have injured and weakened its core as well as outer coil wire and during its forceful retrieval, it had got sheared off. However, the broken and deformed end had remained attached with the catheter thus, preventing disastrous complications such as embolism, perforation, sepsis, endocarditis, and cardiac arrest.…”

Retrieval of Intravascular Fractured Fragment of Tunnelled Double Lumen Catheter in Hemodialysis Patient

“…There a few cases of cardiac tamponade following a fractured fragment of a catheter. Although it was seldom occurred, a fractured intravascular catheter might cause thrombosis in the right atrium [2], [6]. The complication also included cardiac perforation [7].…”

“…If the fractured fragment was remained at the point of skin entry or stay in the vein that can be accessed superficially, a surgical cut-down technique might be preferred as a first approach [6]. The decision of retrieval of the intravascular fractured fragment was often based on the shape, size, and location.…”

Importance of Dermatotomy Incision without Residual Skin Bridge during Central Venous Catheterization

“…Guidewire kinking, knotting, and fracture can and do occur during multiple-step central venous catheter placement using the Seldinger technique [ 2 , 3 ]. In addition to the author’s recommendation to avoid advancing the guidewire against resistance, attempts to advance dilators or catheters through the skin with force or in a direction not parallel to the in situ guidewire can result in guidewire kinking, looping, and fracture.…”