Lost Venous Access Guidewire Identified by Its Late Cervical Protrusion: Case Report

Abstract

We report a pediatric patient who underwent a central venous catheter (CVC) insertion and presented with a sudden protrusion of a guidewire from the neck 26 months later. The guidewire was extracted via femoral venotomy. A 5-cm portion of the guidewire adhering to the superior vena cava wall was left in place. We recommend always using a CVC checklist, inspecting the guidewire before and after insertion, and carefully examining the postinsertion radiographs. This checklist should be mandatory with every CVC insertion, including the perioperative period.

A Double Rarity: Lost intravascular Catheter Guidewire in Persistent Left Superior Vena Cava and Coronary Sinus - A Case Report

“… 8 The retained guidewire is usually detected during a procedure, but there have been cases where a diagnosis was discovered incidentally several months later during routine radiology diagnostics. 9 Possible signs that guide the recognition of guidewire retention include slow backflow from the distal tip or resistance to injection, a missing guidewire after the procedure, or radiological suspicion during radiology diagnostics. 10 , 11 Although a nurse in this case alerted the operator of slow backflow, the operator was not aware of the potential sign of guidewire retention.…”