Accidental guidewire migration following emergency femoral central venous catheterization

Area of Science:

• Pediatric Critical Care Medicine
• Interventional Radiology
• Vascular Access

Background:

• Central venous catheter (CVC) placement is a common procedure in critically ill patients, with femoral venous catheterization frequently used.
• Potential complications, such as guidewire migration, necessitate heightened awareness and preventative strategies.

Observation:

• A rare case of accidental guidewire migration occurred during right transfemoral central venous catheterization in a 12-year-old girl.
• The guidewire migrated from the femoral vein to the left internal jugular vein.

Findings:

• The patient required mechanical ventilation in the Pediatric Intensive Care Unit (PICU) due to status epilepticus and aspiration pneumonia.
• Successful retrieval of the migrated guidewire was performed via a right groin incision by a vascular surgeon.

Implications:

• This case underscores the critical importance of meticulous technique, senior supervision, ultrasound guidance, and checklist use during CVC placement to prevent guidewire migration.
• Prompt recognition and intervention by interventional radiology or vascular surgery are crucial for managing this rare complication.