A complication of double lumen hemocatheter guide wire entrapment in a hemodialysis patient

Double lumen hemocatheter is commonly used for temporary hemodialysis patient and various complications have been documented but few reports of guide wire-related complications. We report a complication of double lumen hemocatheter guide wire entrapment in a 43-year-old female of type 1 diabetes mellitus and hemodialysis patient. She was admitted for left arteriovenous shunt dysfunction and right internal jugular vein hemocatheter chamber clotting was found while on hemodialysis, so a new hemocatheter was changed over guide wire. Guide wire was introduced without any resistance and the clotting hemocatheter was removed. During the procedure, the J-tipped guide wire could not be withdrawn and portable chest radiography revealed the J-tip of the guide wire was in the right ventricle near the region of tricuspid valve. Fluoroscopy was arranged and it also confirmed the J-tip was lying in the ventricle near the tricuspid valve where it was stuck. Snare catheter kit was inserted through the 10 Fr sheath and the cardiologist untied the knot by endovascular snare and removed the guide wire smoothly. This report emphasizes the importance of awareness on guide wire entrapment while inserting double lumen hemocatheter. When a guide wire became hard to withdraw, extracting an entrapped guide wire with fluoroscopy guide and snare catheter is a preferable and minimal invasive approach.