An unusual complication during central venous catheter placement

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.