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J Korean Soc Emerg Med > Volume 24(6); 2013 > Article
Journal of The Korean Society of Emergency Medicine 2013;24(6): 771-774.
Guidewire Entrapment During Central Venous Catheterization
Sanghun Lee, Hanho Doh, Seungchul Lee, Junghun Lee, Junseok Seo
Department of Emergency Medicine, Dongguk University Medical Center Ilsan Hospital, Koyang, Korea. erdohh@naver.com
ABSTRACT
Central venous catheterization is common in the emergency department for monitoring of CVP (central venous pressure), fluid administration, and drug infusions. However, the insertion of a central venous catheter is a technically challenging procedure with known risks and complications. A 94-year-old woman was transferred to an emergency department due to difficulties in removing the guidewire during central catheter insertion through the right subclavian vein. A focused bedside ultrasound showed that the guidewire was improperly positioned in the right internal jugular vein. Upon computed tomographic evaluation, the guidewire perforated the right subclavian vein, looped in the mediastinum, reentered the right internal jugular vein toward the right jugular foramen, and was removed by surgery. In conclusion, as catheter and guidewire entrapment are well-known potential complications of central venous catheterization, when resistance is encountered at any stage of central venous catheterization (especially when removing the entrapped catheter or guidewire) the procedure should be stopped and evaluated with imaging assistance. Clinicians should be aware of more complicated sequelae caused by blunt removal of an entrapped catheter and guidewire, despite its low probability.
Key words: Catheterization, Cantral venous, Patient harm, Case reports
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