Vol 9 | Issue 1 | January-April 2023 | Page: 16-17 | Kashish Garg, Navdeep Kaur, Rishika Goel, Ajay Singh, Venkata Ganesh, Naveen Naik B
Author: Kashish Garg , Navdeep Kaur , Rishika Goel , Ajay Singh , Venkata Ganesh , Naveen Naik B 
 Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
Address of Correspondence
Dr. Ajay Singh,
Assistant Professor, Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
Central venous catheter (CVC) placement is an invasive procedure commonly performed in both paediatric and adult patients.  However, improper insertion technique can lead to unanticipated complications, having an incidence of 12-15%  and guide-wire-related complications being one of them.  Here we have described the unanticipated lodgement of the guidewire in a 3-way stopcock during CVC placement.
We planned for right internal jugular vein CVC insertion under ultrasound guidance using seldinger technique after the induction of general anaesthesia. We secured all three ports of the central venous catheter with three-way stopcocks flushed with normal saline, with the distal most port three-way being open. After the insertion of the introducer needle, the guide wire was inserted and its position was confirmed with ultrasound. During the removal of the guide wire, it got lodged into the distal most port three-way stopcock, moving neither in the forward nor backward direction. Ultimately we detached the three-way stopcock from the distal most port and simultaneously removed the guidewire along with it as a single unit as shown in figures A to D.
CVC complications depend upon the anatomical site, whether blind or ultrasound-assisted and the operator’s experience. It can be mechanical, infectious or thrombotic. Mechanical complications usually occur at the time of insertion and are mainly operator-dependent.  However, infectious or thrombotic complications usually occur later on. The main complications are failure to place the catheter, catheter malposition, arterial puncture, subcutaneous hematoma, hemothorax and cardiac arrest. An unsuccessful insertion attempt is an important predictor of complications.  The incidence of mechanical complications has been significantly decreased from 4% to 7% by the real-time use of ultrasound.  Guidewire-related complications are one of the immediate complications occurring at the time of CVC placement. Recognition and management of guidewire-associated complications are crucial as they can quickly lead to life-threatening situations. Earlier cases have been reported about guidewire entrapment or lost guidewires. [8,9] This case also describes one of the guidewire-associated complications, not been reported so far. A stuck guidewire has to be removed very gently as undue force may break the guidewire, further requiring surgical intervention or fluoroscopic guided removal.  Here we removed the lodged guidewire with 3 way stop cock as a single unit. So three-way stopcock should not be attached to the CVC distal most port through which the guide wire comes out during CVC insertion.
 Safety Committee of Japanese Society of Anesthesiologists. Practical guide for safe central venous catheterization and management 2017. Journal of Anesthesia 2020;34:167–86.
 Zhao, Shenyu MM; Wang, Zhe MD; Zhao, Yu MD. Loss of guidewire and its sequelae after central venous catheterization. Medicine 2019; 98:16513
 Khasawneh, Faisal A, and Roger D Smalligan. Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature. Case Reports in Critical Care. 2011;2011:287261.
 McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl HYPERLINK “https://www.uptodate.com/contents/overview-of-complications-of-central-venous-catheters-and-their-prevention-in-adults/abstract/1” J Med 2003; 348:1123.
 Kornbau, C., Lee, K. C., Hughes, G. D., & Firstenberg, M. S. Central line complications. International Journal of Critical Illness and Injury Science. 2015; 5:170-8.
 Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg. 2007;204:681–96.
 Bhutta ST, Culp WC. Evaluation and management of central venous access complications. Tech Vasc Interv Radiol. 2011;14:217–24.
 Jalwal GK, Rajagopalan V, Bindra A, Goyal K, Rath GP, Kumar A, et al. Percutaneous retrieval of malpositioned, kinked and unraveled guide wire under fluoroscopic guidance during central venous cannulation. J Anaesthesiol Clin Pharmacol. 2014;30:582.
 Vannucci A, Jeffcoat A, Ifune C, Salinas C, Duncan JR, Wall M. Special article: Retained guidewires after intraoperative placement of central venous catheters. Anesth Analg. 2013;117:102–8
|How to Cite this Article: Garg K, Kaur N, Goel R, Singh A, Ganesh V, Naik B N An | Unexpected Case of Lodged Guidewire During Central Venous Catheter Insertion | Journal of Anaesthesia and Critical Care Case Reports | January-April 2023; 9(1): 16-17 | https://doi.org/10.13107/jaccr.2023.v09i01.214|
(Abstract Text HTML) (Download PDF)