Guidewire Retention by the Venous Cannula of Veno-Arterial Extracorporeal Membrane Oxygenation

TL;DR

This paper discusses the rare but serious risk of guidewire retention during central venous catheter placement in patients on ECMO due to strong venous suction.

Contribution

Highlights the unique risk of guidewire retention caused by ECMO-induced negative venous pressure during catheter insertion.

Findings

ECMO generates significant negative pressure in the venous system.

This pressure can cause unsecured guidewires to be sucked into the ECMO cannula.

Special caution is needed during CVC placement in ECMO patients.

Abstract

While insertion of a central venous catheter (CVC) for intravascular access, diagnosis, and intensive care medical treatment is frequently needed in critically ill patients, retention of the guidewire used for CVC placement with Seldinger’s technique is a very rare complication. In patients treated with extracorporeal membrane oxygenation (ECMO), significant negative pressures in the thoracal and abdominal venous system are generated by the venous ECMO drainage cannula. Therefore, during CVC placement in patients treated with ECMO, special vigilance is required because the significant negative pressures generated by the venous ECMO drainage cannula facilitate venous suction of an unsecured guidewire.

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