Regarding: “Modification of the Syringe Plunger Is Not Required to Facilitate Wire Threading in Endovascular Procedures”

Abstract

To the Editors, Based on the World Health Organization Guidelines for Safe Surgery, 1 Ng et al 2 recently expressed their concern for the risk of retention of one piece of the syringe plunger in a surgical wound following removal of its ends. Fortunately, this is not the case. First, as mentioned by the authors, there is a zero risk of retention in a purely endovascular procedure. With regard to hybrid procedures, the risk is also negligible since the operating area of the device (the tail of the wire) is usually the furthest spot from the incision. But above all, as we routinely do, the easiest way to ensure the risks are effectively nil is to immediately discard both ends of the plunger once the device is prepared. Although we set up the GTI (guidewire threading instrument) on site before starting the endovascular procedure, it can also be prepared and sterilized in advance. Hopefully, we will have an "ad hoc" manufactured GTI device available in our disposable endovascular packs at some time. On the other hand, stability is a crucial aspect to reduce cannulation time. Removal of both ends exposes the furrows of the plunger and reduces the likelihood of the device rolling across the table, especially when cannulating on a nonflat surface (eg, on the patient), significantly improving stability of the whole system. Finally, the "modified syringe plunger" 3 compared with the former version described by our group 4 results in a less bulky device that facilitates guidewire/catheter manipulation since both hands are comfortably positioned on the table. We are grateful for the interest of Dr Ng and colleagues in our article and for giving us the opportunity to revisit and clarify the technical details of our maneuver. We hope that this device helps interventionists facilitate guidewire threading of low-profile catheters.