University of Toledo, Toledo, OH
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Fellow Case Report Poster - Critical Care II
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
INTRODUCTION: In the acute care setting central venous catheters’ play a vital role in the treatment and monitoring of critically ill patients. The use of central venous catheters is associated with adverse events that are both hazardous to patients and expensive to treat. Mechanical complications are reported to occur in 5 to 19 percent of patients. and dislodging IVC filter is a possible complication
CASE PRESENTATION: 73 year old female with past medical history of DVT s/p IVC filter and multiple other comorbidities who presented to the emergency department with altered mental status, sepsis and respiratory failure. Right IJ line was attempted for volume resuscitation and administration of life saving medications. During cannulation of catheter good blood return was noted on first attempt and the guide wire was advanced. During advancement of the guide wire it was noted that it was met with no resistance and the physician continued to feed the guide wire almost in its entirety. Upon removing the guide wire, the attending physician noted resistance and was unable to safely remove the guide wire. Imaging later revealed that the guide wire was actually lodged into the IVC filter. A second IV access was established, while a dedicated staff member monitored the guide wire closely Interventional radiology was called and patient was taken for guide wire removal under fluoroscopy. Intraoperative imaging revealed the J portion was wedged into the apex of the Greenfield filter. A long 6 French dilator had to be used to dislodge the guide wire from the filter.
DISCUSSION: The majority of complications associated with central line placement is mechanical and user dependent. The use of ultrasound has significantly reduced the number of adverse events associated with line placements. In this case, inserting the guide wire too far could have caused significant morbidity. This can be avoided by shortening the length of the guide wire, in turn limiting the distance it can be advanced to 16-20 cm.
CONCLUSIONS: Marking the length from the J end of the guidewire by manufacturing companies can help physicians avoiding overinserting the guidewire and avoid complications.
Reference #1: Preventing Complications of Central Venous Catheterization D McGee, M Gould. N Engl J Med 2003; 348:1123-1133March 20, 2003DOI: 10.1056/NEJMra011883
Reference #2: Guidewire Dislodgment of Inferior Vena Cava Filters During Insertion of Central Venous Catheters S Kang, M Borge, M Mansour, N Labropoulos, W Baker VASC ENDOVASCULAR SURG September 1997 31: 587-593,
DISCLOSURE: The following authors have nothing to disclose: Mohammad Taleb, Ramzyah Kaid, Abdulmonam Ali
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