J Korean Surg Soc.  2013 Nov;85(5):244-247.

Use of video-assisted thoracoscopic surgery to retrieve a broken guidewire

• Cho JB
• Park IY
• Sung KY
• Baek JM
• Lee JH
• Lee DS

Abstract

Subclavian venous catheterization was once widely used for volume resuscitation, emergency venous access, chemotherapy, parenteral nutrition, and hemodialysis. However, its use has drastically reduced recently because of life-threatening complications such as hemothorax, pneumothorax. In this case, a patient admitted for a scheduled operation underwent right subclavian venous catheterization for preoperative, intraoperative, and postoperative volume resuscitation and parenteral nutrition. The procedure was performed by an experienced senior resident. Despite detecting slight resistance during the guidewire insertion, the resident continued the procedure to the point of being unable to advance or remove it, then attempted to forcefully remove the guidewire, but it broke and became entrapped within the thorax. We tried to remove the guidewire through infraclavicular skin incision but failed. So video-assisted thoracoscopic surgery was used to remove the broken guidewire. This incident demonstrates the risks of subclavian venous catheterization and the importance of using a proper and gentle technique.

Keyword

Broken guidewire; Central venous catheterization; Complications; Subclavian venous catheterization; Video assisted thoracic surgery

MeSH Terms

Catheterization
Catheterization, Central Venous
Catheters
Drug Therapy
Emergencies
Hemothorax
Humans
Parenteral Nutrition
Pneumothorax
Renal Dialysis
Resuscitation
Skin
Thoracic Surgery, Video-Assisted*
Thorax

Figure

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  Fig. 1 The Spectrum Central Venous Catheter Set (length, 20 cm; size, 7.0 F; William A. Cook Australia Pty. Ltd.).

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  Fig. 2 J-shaped guide wire tip.

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  Fig. 3 (A) Chest radiography showed looped and entrapped guide wire. (B) Close up view of entrapped guide wire.

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  Fig. 4 Chest computed tomographic scan showed entrapped guide wire located outside the vein.

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  Fig. 5 (A) Entrapped guide wire visualized on thoracoscopy. (B) Completely removed guide wire.

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