Abstract
Purpose
To describe the successful removal of a knotted Seldinger wire from a subclavian vein, and review the design and structure of guidewires to formulate recommendations to minimize complications associated with the Seldinger technique.
Clinical features
An 81-yr-old patient suffered from an intra-vascular knotting of a Seldinger wire during subclavian venous cannulation. We describe a technique for successful removal of knotted guidewire under fluoroscopic guidance using the vessel dilator of a central venous cannulation kit. In this case, the technique was successful without associated immediate or delayed complications. Although central venous cannulation with the Seldinger technique is a commonly performed procedure, it may result in numerous complications, including kinking, and rarely complete knotting of the guidewire.
Conclusions
A thorough understanding of procedural complications and physical characteristics of the guidewire is vital in order to ensure patient safety when using the Seldinger technique for central venous cannulation. We have reviewed the relevant literature for guidewire design and structure, associated complications, and provide recommendations for safe use of guidewires.
Résumé
Objectif
Décrire l’extraction réussie d’une broche guide de Seldinger nouée hors d’une veine sous-clavière et passer en revue la conception et la structure des broches guides afin de formuler des recommandations pour minimiser les complications associées à la technique de Seldinger.
Éléments cliniques
Un patient de 81 ans fut victime du nouage intravasculaire d’une broche guide de Seldinger lors d’une canulation veineuse sous-clavière. Nous décrivons une technique réussie d’extraction de la broche guide nouée sous monitorage fluoroscopique, qui se sert du dilatateur de vaisseau d’un kit de canulation veineuse centrale. Dans ce cas, la technique a réussi sans engendrer de complications immédiates ou différées associées. Bien que la canulation veineuse centrale avec la technique de Seldinger soit une procédure couramment effectuée, elle peut provoquer de nombreuses complications, y compris le tordage, et plus rarement le nouage complet de la broche guide.
Conclusion
Une compréhension exhaustive des complications procédurales et des caractéristiques physiques de la broche guide est essentielle afin d’assurer la sécurité des patients lors de l’utilisation de la technique de Seldinger pour la canulation veineuse centrale. Nous avons passé en revue la littérature pertinente au sujet de la conception et de la structure de la broche guide, des complications associées, et fournissons des recommandations pour un usage sécuritaire des broches guides.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Merrer J, De Jonghe B, Golliot F, et al;French Catheter Study Group in Intensive Care. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001; 286: 700–7.
Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian-vein catheterization. N Engl J Med 1994; 331: 1735–8.
Wang LP, Einarsson E. A complication of subclavian vein catheterisation. Extravascular knotting of a guide-wire. Acta Anaesthesiol Scand 1987; 31: 187–8.
Carp entier JP, Braz da Silva J, Choukroun G. Formation of a knot in a J spiral metallic guide: a complication of the Seldinger method (French). Cah Anesthesiol 1991; 39: 277–8.
Koundouris C, Tornaris G, Charopoulos I, Vounasis A, Solomou G. Subclavian vein flexible guidewire knotting. A potential serious complication in hemodialysis patients. Chirurgia (Bucur) 2004; 99: 61–4.
Monaca E, Trojan S, Lynch J, Doehn M, Wappler F. Broken guide wire — a fault of design? Can J Anesth 2005; 52: 801–4.
Schwartz AJ, Horrow JC, Jobes DR, Ellison N. Guide wires--a caution. Crit Care Med 1981; 9: 347–8.
Triolo P. Using risk analysis to develop coated medical devices. Available from URL; http://www.devic-elink.com/mddi/archive/05/01/006.html (accessed 28/05/06) 2005.
U.S. Food and Drug Administration. Recognition and use of consensus standards; final guidance for industry and FDA staff, (Rockville, MD: FDA:); Available from URL; http: //www.fda.gov/cdrh/ost/guidance/321. html (accessed 28/05/06) CDRH, June 2001.
Sutou Y, Omori T, Furukawa A, et al. Development of medical guide wire of Cu-Al-Mn-base superelastic alloy with functionally graded characteristics. J Biomed Mater Res B Appl Biomater 2004; 69: 64–9.
Hoogsteden L, Filshie J, Querci della Rovere G. Knotted guidewire — A complication of Hickman line insertion. Anaesthesia 1996; 51: 713.
Chhabra B, Kiran S, Sekhri C. Shearing of guide wire: a complication of central venous catheterization. Journal of Anaesthesiology 2002; 18: 99–101.
Casserly IP, Goldstein JA, Rogers JH, Lasala JM. Paradoxical embolization of a fractured guidewire: successful retrieval from left atrium using a snare device. Catheter Cardiovasc Interv 2002; 57: 34–8.
Lee TY, Sung CS, Chu YC, Liou JT, Lui PW. Incidence and risk factors of guidewire-induced arrhythmia during internal jugular venous catheterization: comparison of marked and plain J-wires. J Clin Anesth 1996; 8: 348–51.
Quiney NF. Sudden death after central venous cannulation. Can J Anaesth 1994; 41: 513–5.
Palmer S, Solano T. Contamination of guidewires during insertion of central venous catheters in an intensive care setting. Infect Control Hosp Epidemiol 2005; 26: 506–7.
Lum TE, Fairbanks RJ, Pennington EC, Zwemer FL. Profiles in patient safety: misplaced femoral line guide-wire and multiple failures to detect the foreign body on chest radiography. Acad Emerg Med 2005; 12: 658–62.
Duong MH, Jensen WA, Kirsch CM, Wehner JH, Kagawa FT. An unusual complication during central venous catheter placement. J Clin Anesth 2001; 13: 131–2.
Liddell RP, Spinosa DJ, Matsumoto AH, Angle JF, Hagspiel KD. Guidewire entrapment in a Greenfield IVC filter: ’rail and reins technique’. Clin Radiol 2000; 55: 878–81.
Cavatorta F, Campisi S, Fiorini F. Fatal pericardial tamponade by a guide wire during jugular catheter insertion. Nephron 1998; 79: 352.
Booth SA, Norton B, Mulvey DA. Central venous catheterization and fatal cardiac tamponade. Br J Anaesth 2001; 87: 298–302.
Jankovic Z, Boon A, Prasad R. Fatal haemothorax following large-bore percutaneous cannulation before liver transplantation. Br J Anaesth 2005; 95: 472–6.
Wong CS, Wong KL, Sit KF, Chen CC, Sia SL, Wei TT. Guide wire knotting in the femoral vein during central venous catheterization (Chinese). Ma Zui Xue Za Zhi 1992; 30: 55–7.
Galloway S, Bodenham A. Ultrasound imaging of the axillary vein--anatomical basis for central venous access. Br J Anaesth 2003; 90: 589–95.
Sharma A, Bodenham AR, Mallick A. Ultrasound-guided infraclavicular axillary vein cannulation for central venous access. Br J Anaesth 2004; 93: 188–92.
Pachai A. Guidewire knot formation during insertion of a central venous catheter (Danish). Ugeskr Laeger 1997; 159: 5534–5.
Author information
Authors and Affiliations
Corresponding author
Additional information
There was no funding for this report and the authors have no conflicts of interest with the manufacturers of the medical devices described in this report.
B B. Braun. Manufacturer’s instructions for use. Central venous catheter for Infusion therapy. Melsungen AG, Melsungen, Germany: February 2002.
Rights and permissions
About this article
Cite this article
Khan, K.Z., Graham, D., Ermenyi, A. et al. Case report: Managing a knotted Seldinger wire in the subclavian vein during central venous cannulation. Can J Anesth 54, 375–379 (2007). https://doi.org/10.1007/BF03022660
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03022660