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An unusual complication during central venous catheter placement
M H Duong1, W A Jensen, C M Kirsch
1Department of Medicine and the Division of Respiratory and Critical Care Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
Journal of Clinical Anesthesia
|May 2, 2001
Summary
A guidewire entangled in an inferior vena cava (IVC) filter during central catheter placement was successfully removed. Interventional radiologists used a snare tip catheter to resolve this rare complication, ensuring patient safety.
Area of Science:
- Interventional Radiology
- Infectious Diseases
- Vascular Access
Background:
- Central venous catheterization is crucial for managing disseminated infections like Coccidioides imitis.
- Inferior vena cava (IVC) filters are used to prevent pulmonary embolism in patients with deep venous thrombosis.
- The Seldinger technique is a standard method for central venous catheter placement.
Observation:
- A guidewire became entangled in the apex of an IVC filter during right internal jugular catheter placement.
- Fluoroscopy confirmed the guidewire's entanglement within the IVC filter's structure.
- The patient had a history of deep venous thrombosis necessitating the IVC filter.
Findings:
- The entangled guidewire posed a significant challenge to catheter removal.
- Interventional radiologists successfully retrieved the guidewire using a snare tip catheter inserted via the contralateral femoral vein.
- This case highlights a rare but critical complication during central venous access in patients with IVC filters.
Implications:
- This successful retrieval demonstrates the utility of specialized endovascular techniques in managing complex central venous access complications.
- Awareness of potential guidewire-IVC filter interactions is crucial for procedural safety.
- Interventional radiology expertise is vital for resolving such iatrogenic complications, minimizing patient risk.