Loss of guidewire and its sequelae after central venous catheterization: A case report

Abstract

Rationale: Central venous catheterization is a common tool used to monitor central venous pressure and administer fluid medications in patients undergoing surgery. The loss of a broken guide wire into the circulation is a rare and preventable complication. Here, we report a peculiar case of a missed guidewire puncturing the aortic arch and cerebrum.

Patient concerns: A 53-year-old man with complaints of an intermittent headache and right swollen ankle following central venous catheterization.

Diagnoses: Using computed tomography; the patient was diagnosed with the loss of a guide wire in his body. The guide wire had migrated to the brain and punctured the vascular wall of the aortic arch.

Interventions: Due to the risks of surgery, the patient was advised to have a follow-up visit once every 3 months.

Outcomes: At present, the patient could live like a normal person, although he suffers from intermittent headaches.

Lessons: The loss of a guide wire is a completely preventable complication, provided that a hold on the tip of the wire is maintained during placement, and the correct safety measurements and protocols are followed.

Figure 1

3D reconstruction of computed tomography showing one of guide wire had entered in the right brachiocephalic vena cava and the other one had entered in the cerebrum via the aortic arch.

Figure 2

3D reconstruction of computed tomography showing the position of the guide wire in the cerebrum.

Figure 3

Computed tomography showing guide wire had punctured the vascular wall of the aortic arch to reach the cerebrum.

Figure 4

Computed tomography angiography showing guide wire had punctured the vascular wall of the aortic arch to reach the cerebrum.

Figure 5

The relative position between brachiocephalic artery (A), left common carotid (B), guide wire (C), and left subclavian artery (D).