I was discussing central line placement complications with medical students a few days ago. Some of them are illustrated with horrifying details in the NEJM."What should you do if you lose a guide wire during central line placement?", I asked.
"We could use a strong magnet to pull it out", one of the students suggested.
Well, not really.
You should call interventional radiology immediately and the radiologist will extract the wire under fluoroscopic guidance by using another wire to hook up and pull out the lost one.
A few examples of different approaches to extract lost guide wires are listed in the British Journal of Anaesthesia.
We have published free illustrated step-by-step procedure guides to central placement with and without ultrasound. The guides are available as web pages and Windows Mobile/Palm downloads.
References:
Central Line Placement: A Step-by-Step Procedure Guide with Photos
Loss of the guide wire: mishap or blunder? British Journal of Anaesthesia, 2002, Vol. 88, No. 1 144-146.
Lost guide wire during central venous cannulation and its surgical retrieval. Kumar S, Eapen S, Vaid VN, Bhagwat AR. Indian J Surg 2006;68:33-34.
Image source: Wikipedia, public domain.
Further reading:
Lost Guide Wire. Radiology Picture of the Day.
A Big Time Mistake. Ten out of Ten: My experiences as an ER doc, 02/2008.
"Signs of guide wire loss:
ReplyDeleteThe guide wire is missing."
Had to laugh at that one...
Hope you don't mind the link from my blog to your step by step procedure guide. That is an awesome resource, something I wish I had available to me as an intern.
ReplyDeleteI'm glad you find it useful. Thank you for the link.
ReplyDeleteI have on a few occasions prevented colleagues from flushing guidewires down central lines.. but guess what I did the other day? .. Yes, lost a guide wire into a femoral vein. It was in a man with hepatic encephalopathy who moved around during placement. The sterile field needed constant protection. I was at the end of a long shift. It was very embarrassing..It happened because I fed too much guide wire in and then let go of it while feeding the line over the wire.. inadvertently, I was feeding the wire in at the same time. Never let go of that wire until you are removing it at the end of the procedure!
ReplyDelete