Guide wire misadventure: a duo of inadvertent intravascular migration

TL;DR

Two rare cases of guide wire migration during central venous catheterization are reported, highlighting the importance of careful management to avoid life-threatening complications.

Contribution

The first reported case series of intrathoracic migration of retained guide wires during central venous catheterization.

Findings

A 25-year-old male developed a right hemothorax due to guide wire migration into the thoracic cavity.

A 49-year-old female had a retained guide wire migrate from the subclavian to the femoral vein with thrombosis.

Both cases were successfully managed with a multidisciplinary approach, emphasizing the need for vigilance in guide wire management.

Abstract

Central venous catheterization (CVC) is an integral part of patient care in the intensive care unit. The Seldinger technique, known for its minimal invasiveness, has become the standard for CVC insertion. Despite the technique’s effectiveness and safety, guide wires—integral to the procedure—carry risks, including a rare but serious complication: intrathoracic migration of a retained guide wire. Although the overall complication rate for CVC insertion is around 11.8%, intrathoracic migration of a guide wire has not been previously reported, underscoring its rarity and the necessity of meticulous guide wire management. We present a case series of two patients who experienced this rare complication. In the first case, a 25-year-old male developed a right hemothorax after the guide wire migrated into the thoracic cavity. In the second case, a 49-year-old female had a retained intravascular guide wire that migrated from the subclavian vein to the femoral vein, complicated by thrombosis. Both patients underwent successful retrieval and treatment through a multidisciplinary approach. These cases highlight the importance of vigilant guide wire management and prompt recognition of this potentially life-threatening complication. This case series emphasizes the need for healthcare providers to be aware of the risks associated with central venous catheterization and to adopt a multidisciplinary approach to manage these rare but serious complications.

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