Percutaneous Retrieval of a Lost Guidewire That Caused Cardiac Tamponade
2007; Lippincott Williams & Wilkins; Volume: 115; Issue: 24 Linguagem: Inglês
10.1161/circulationaha.107.689000
ISSN1524-4539
AutoresDiego Pérez-Díez, Jorge Salgado‐Fernández, Nicolás Vázquez‐González, Ramón Calviño‐Santos, José Manuel Vázquez‐Rodríguez, Guillermo Aldama-López, Juan Javier García-Barreiro, Alfonso Castro‐Beiras,
Tópico(s)Cardiac Structural Anomalies and Repair
ResumoHomeCirculationVol. 115, No. 24Percutaneous Retrieval of a Lost Guidewire That Caused Cardiac Tamponade Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBPercutaneous Retrieval of a Lost Guidewire That Caused Cardiac Tamponade Diego Pérez-Díez, MD, Jorge Salgado-Fernández, MD, Nicolás Vázquez-González, MD, Ramón Calviño-Santos, MD, José Manuel Vázquez-Rodríguez, MD, Guillermo Aldama-López, MD, Juan Javier García-Barreiro, MD and Alfonso Castro-Beiras, MD, PhD Diego Pérez-DíezDiego Pérez-Díez From the Department of Cardiology (D.P.-D., J.S.-F., N.V.-G., R.C.-S., J.M.V.-R., G.A.-L., A.C.-B.) and the Burn Unit and Plastic Surgery Department (J.J.G.-B.), Hospital Juan Canalejo, A Coruña, Spain. , Jorge Salgado-FernándezJorge Salgado-Fernández From the Department of Cardiology (D.P.-D., J.S.-F., N.V.-G., R.C.-S., J.M.V.-R., G.A.-L., A.C.-B.) and the Burn Unit and Plastic Surgery Department (J.J.G.-B.), Hospital Juan Canalejo, A Coruña, Spain. , Nicolás Vázquez-GonzálezNicolás Vázquez-González From the Department of Cardiology (D.P.-D., J.S.-F., N.V.-G., R.C.-S., J.M.V.-R., G.A.-L., A.C.-B.) and the Burn Unit and Plastic Surgery Department (J.J.G.-B.), Hospital Juan Canalejo, A Coruña, Spain. , Ramón Calviño-SantosRamón Calviño-Santos From the Department of Cardiology (D.P.-D., J.S.-F., N.V.-G., R.C.-S., J.M.V.-R., G.A.-L., A.C.-B.) and the Burn Unit and Plastic Surgery Department (J.J.G.-B.), Hospital Juan Canalejo, A Coruña, Spain. , José Manuel Vázquez-RodríguezJosé Manuel Vázquez-Rodríguez From the Department of Cardiology (D.P.-D., J.S.-F., N.V.-G., R.C.-S., J.M.V.-R., G.A.-L., A.C.-B.) and the Burn Unit and Plastic Surgery Department (J.J.G.-B.), Hospital Juan Canalejo, A Coruña, Spain. , Guillermo Aldama-LópezGuillermo Aldama-López From the Department of Cardiology (D.P.-D., J.S.-F., N.V.-G., R.C.-S., J.M.V.-R., G.A.-L., A.C.-B.) and the Burn Unit and Plastic Surgery Department (J.J.G.-B.), Hospital Juan Canalejo, A Coruña, Spain. , Juan Javier García-BarreiroJuan Javier García-Barreiro From the Department of Cardiology (D.P.-D., J.S.-F., N.V.-G., R.C.-S., J.M.V.-R., G.A.-L., A.C.-B.) and the Burn Unit and Plastic Surgery Department (J.J.G.-B.), Hospital Juan Canalejo, A Coruña, Spain. and Alfonso Castro-BeirasAlfonso Castro-Beiras From the Department of Cardiology (D.P.-D., J.S.-F., N.V.-G., R.C.-S., J.M.V.-R., G.A.-L., A.C.-B.) and the Burn Unit and Plastic Surgery Department (J.J.G.-B.), Hospital Juan Canalejo, A Coruña, Spain. Originally published19 Jun 2007https://doi.org/10.1161/CIRCULATIONAHA.107.689000Circulation. 2007;115:e629–e631Central venous access techniques are commonly used for diagnosis and treatment, especially in critical care units. Complications may arise in as many as 15% of these procedures, although loss of the complete guide wire as a result of deficient insertion with the Seldinger technique has rarely been reported.1 A 48-year-old man was admitted to the burn unit in critical condition after an explosion in a fireworks factory. He needed mechanical ventilation and multiple central venous catheters. During insertion of a central venous catheter through the right femoral vein with the Seldinger technique, inadvertent loss of a 60-cm guide wire occurred. The guide wire was visible in chest x-rays taken while the patient was still in the burn unit (Figure 1), but its presence was overlooked at that time. During the next year the patient underwent several surgical interventions for palliation of sequelae; the guide wire was discovered in preoperative studies, but because the patient was asymptomatic and the guide wire appeared to be immobilized, it was decided to leave it in place. Three years after the initial injury, the patient was admitted to the emergency room with syncope and chest pain consistent with acute pericarditis. An echocardiogram showed severe pericardial effusion with diastolic collapse of the right atrium and ventricle, which suggested cardiac tamponade. Subxiphoid pericardiocentesis drained 800 cc of hemorrhagic fluid with no complications and brought about clinical and echocardiographic improvement. The chest film (Figure 2) showed that the guide wire was fractured in the right atrium, with sharp ends on both fragments caused by the protrusion of the core wire (Figure 3). The fractured guide wire was considered to have perforated the right atrium and caused subsequent tamponade. A few days later, a fluoroscopic examination was performed (online Data Supplement Movie), which clearly showed the fracture of the guide wire and further migration of the lower fragment when compared to the chest films taken on admission. The patient was accordingly scheduled for percutaneous removal of the guide wire fragments after resolution of pericarditis. Download figureDownload PowerPointFigure 1. Chest x-ray obtained the day after insertion of the central venous catheter shows a guide wire that extends from the inferior vena cava to the right jugular vein (arrows).Download figureDownload PowerPointFigure 2. Chest x-ray on admission for cardiac tamponade shows a guide wire that extends from the inferior vena cava to the right subclavian vein (arrows). A, Posteroanterior view. B, Lateral view.Download figureDownload PowerPointFigure 3. Magnification of the posteroanterior chest x-ray shows the sharp ends of the fractured guide wire in the right atrium.To remove the guide wire fragments we used a double vascular access: the right femoral vein to retrieve the upper fragment and the right subclavian vein to remove the lower fragment. A 10-mm snare (Amplatz Goose Neck Microsnare, Microvena Corp, White Bear Lake, Minn) was used through an 8F multipurpose catheter,2 and the guide wire fragment, the snare, the catheter, and the sheath were removed together.Percutaneous removal should be the first choice in the management of intravascular foreign bodies and should be performed as soon as the diagnosis is made, although retrieval should still be attempted several months or years after the event, because late complications may appear.The online-only Data Supplement, which consists of a movie, is available with this article at http://circ.ahajournals.org/cgi/content/full/115/24/e629/DC1.DisclosuresNone.FootnotesCorrespondence to Dr Jorge Salgado Fernández, Department of Cardiology, Hospital Juan Canalejo, Xubias de Arriba 84, 15006 A Coruña, Spain. E-mail [email protected]References1 Grabenwoeger F, Bardach G, Dock W, Pinterits F. Percutaneous extraction of centrally embolized foreign bodies: a report of 16 cases. Br J Radiol. 1988; 61: 1014–1018.CrossrefMedlineGoogle Scholar2 Park JH, Yoon DY, Han JK, Kim SH, Han MC. Retrieval of intravascular foreign bodies with the snare and catheter capture technique. J Vasc Interv Radiol. 1992; 3: 581–582.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Rani A and Malik P (2019) Guidewire Mishap: An Avoidable Iatrogenic Complication, Indian Journal of Critical Care Medicine, 10.5005/jp-journals-10071-23225, 23:8, (382-383), Online publication date: 1-Aug-2019. Alves D and Carvalho C (2018) Fio‐guia perdido – lições aprendidas, Brazilian Journal of Anesthesiology, 10.1016/j.bjan.2016.12.004, 68:2, (183-185), Online publication date: 1-Mar-2018. Alves D and Carvalho C (2018) Lost guide wire – lessons learned, Brazilian Journal of Anesthesiology (English Edition), 10.1016/j.bjane.2015.03.013, 68:2, (183-185), Online publication date: 1-Mar-2018. Chatzimichailidou M, Ward J, Horberry T and Clarkson P (2017) A Comparison of the Bow-Tie and STAMP Approaches to Reduce the Risk of Surgical Instrument Retention, Risk Analysis, 10.1111/risa.12897, 38:5, (978-990), Online publication date: 1-May-2018. Kim Y, Yu J, Kim Y and Lee W (2015) Retained guidewire penetrating through the aorta into the thorax: an unusual cause of recurrent bilateral pneumothorax, European Journal of Cardio-Thoracic Surgery, 10.1093/ejcts/ezv365, 49:1, (e33-e35), Online publication date: 1-Jan-2016. Pokharel K, Biswas B, Tripathi M and Subedi A (2015) Missed Central Venous Guide Wires, Critical Care Medicine, 10.1097/CCM.0000000000001012, 43:8, (1745-1756), Online publication date: 1-Aug-2015. Williams T, Bowdle T, Winters B, Pavkovic S and Szekendi M (2014) Guidewires Unintentionally Retained During Central Venous Catheterization, Journal of the Association for Vascular Access, 10.1016/j.java.2013.12.001, 19:1, (29-34), Online publication date: 1-Mar-2014. Nannarone S, Falchero V, Gialletti R, Beccati F and Pepe M (2012) Successful removal of a guidewire from the jugular vein of a mature horse, Equine Veterinary Education, 10.1111/j.2042-3292.2012.00397.x, 25:4, (173-176), Online publication date: 1-Apr-2013. Gulel O, Soylu K, Yuksel S, Keceligil H and Akcay M (2013) A Forgotten Guidewire Causing Intracardiac Multiple Thrombi With Paradoxical and Pulmonary Embolism, Canadian Journal of Cardiology, 10.1016/j.cjca.2012.12.010, 29:6, (751.e15-751.e16), Online publication date: 1-Jun-2013. Omar H, Sprenker C, Karlnoski R, Mangar D, Miller J and Camporesi E (2013) The incidence of retained guidewires after central venous catheterization in a tertiary care center, The American Journal of Emergency Medicine, 10.1016/j.ajem.2013.07.009, 31:10, (1528-1530), Online publication date: 1-Oct-2013. Richa F, Yazigi A, El-Hage C, Tabet G and Yazbeck P (2010) Une technique simple pour retirer le guide métallique oublié dans un cathéter veineux central, Annales Françaises d'Anesthésie et de Réanimation, 10.1016/j.annfar.2010.07.005, 29:10, (742-743), Online publication date: 1-Oct-2010. Belhadj A, Balkhi H, Kechna H, Azendour H, Haimeur C and Drissi Kamili N (2010) Oubli du guide métallique lors d'un cathétérisme veineux central, Annales Françaises d'Anesthésie et de Réanimation, 10.1016/j.annfar.2010.01.011, 29:3, (253-254), Online publication date: 1-Mar-2010. Maddah G, Abdollahi A, Jangjoo A, Noorshafiee S, Abdollahi M and Hasanzadeh A (2012) Minimally Invasive Surgery in Loss of the Guide Wire: Case Report, Journal of Minimally Invasive Surgical Sciences, 10.5812/jmiss.3795, 1:3, (108-110) Maddah G, Abdollahi A, Jangjoo A, Noorshafiee S, Abdollahi M and Hasanzadeh A (2013) Minimally Invasive Surgery in Loss of the Guide Wire: Case Report, Journal of Minimally Invasive Surgical Sciences, 10.17795/minsurgery-3795, 2:1, (108-10) June 19, 2007Vol 115, Issue 24 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.689000PMID: 17576875 Originally publishedJune 19, 2007 PDF download Advertisement SubjectsCatheter-Based Coronary and Valvular InterventionsImaging
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