Loss of Guide Wire: A Lesson Learnt Review of Literature
A 60-year-old woman presented to the emergency department with complaints of generalized abdominal pain, constipation, and fever. Patient was hospitalized with primary diagnosis of intestinal obstruction. Due to patient's history of heart disease, the central venous catheterization was done for fluid resuscitation via the right internal jugular (IJ) vein using the Seldinger technique. The catheter was inserted by a 1st-year surgical resident with no supervision by senior residents. No complications or difficulties in cannulation were reported; back flow was also normal. The catheter tray was checked for the guide wire after the procedure which was missing. After the patient was stabilized, she underwent chest X-ray, plain abdominal radiography, and ultrasonography and the patient was admitted in surgical intensive care unit. Resident noticed the guide wire in chest and abdominal radiographs. The radiographs showed that the catheter had entered in the IVC via the right IJ vein and then, had remained in the right iliac vein at the point of bifurcation into the internal and external iliac veins [Figures and ]. Based on the consultation with the vascular surgeons and radiologists, the patient underwent exploration of right iliac vein. The method was successful and the retained guide wire was removed from right external iliac vein. The procedure was successful and intestinal obstruction was managed conservatively. Her hospital stay was uneventful.