A Devastating Complication of Central Venous Catheter Insertion

Retained guidewire is a major complication of central line placement. We present a patient with infective endocarditis caused by a retained guidewire. A young man admitted to our emergency department complained of debilitating weakness, productive cough, and fever for seven days. Chest radiography showed some lesions in both lungs as well as a retained guidewire. Past history revealed a thermal burn injury one month before, during which an internal jugular central venous line was inserted. Echocardiography showed multiple large vegetations in right atrium and right ventricle. Thus, infective endocarditis and multiple embolic lung lesions were treated with empirical antibiotics. Guidewire was removed by vascular surgery service. Unfortunately, the patient died before undergoing open-heart surgical intervention. It is believed that central vein catheterization requires special attention to perform through the Seldinger technique skillfully and under supervision to avoid preventable complications.