Use of video-assisted thoracoscopic surgery to retrieve a broken guidewire
A 79-year-old female patient diagnosed with ascending colon cancer was admitted to the Division of Colon and Rectal Surgery of our institution for a scheduled operation on July 23, 2012. At admission, the patient's calculated Acute Physiology and Chronic Health Evaluation II score was 10 with a predicted death rate of 11.3%. Central venous catheterization was performed for preoperative, intraoperative, and postoperative volume resuscitation and nutritional therapy. A senior surgical resident used the landmark method to perform catheterization of the right subclavian vein. The Spectrum Central Venous Catheter Set (length, 20 cm; size, 7.0 F; William A. Cook Australia Pty. Ltd., Brisbane, Australia) was used (). The included guidewire had a J-tip ().\nThe right subclavian vein was successfully punctured using the Seldinger technique, and the guidewire was then inserted. The patient was not obese, and her anatomic landmarks were clear. Slight resistance was detected during the guidewire insertion process, but the resident proceeded with it. When guidewire advancement was not possible, its removal was attempted. However, by this point, it could be neither advanced nor removed because of resistance. Forced removal was attempted but resulted in guidewire breakage and entrapment. Its location could not be determined by palpation. Chest radiography was immediately performed to determine the position of the guidewire, and the results indicated guidewire looping and entrapment within the upper right clavicle (). Chest computed tomography scans revealed that the broken guidewire was outside the vein and had not induced hemothorax, pneumothorax, or hematoma of the soft tissues (). After we had explained this to the patient, under local anesthesia, we tried to remove the broken guidewire through infraclavicular skin incision but we could not find the guidewire.\nThe patient was transferred to the operating room for the scheduled operation and underwent VATS of the right thorax. The operation took 120 minutes. The surgical manifestation was metallic foreign body impaction in the upper chest wall that was successfully removed (). The patient was discharged 14 days after the scheduled right colectomy without significant complications. Volume resuscitation was conducted through the internal jugular vein during the operation, while nutritional support was delivered via peripheral venous access.