Lost Venous Access Guidewire Identified by Its Late Cervical Protrusion: Case Report

We report a pediatric patient who underwent a central venous catheter (CVC) insertion and presented with a sudden protrusion of a guidewire from the neck 26 months later. The guidewire was extracted via femoral venotomy. A 5-cm portion of the guidewire adhering to the superior vena cava wall was left in place. We recommend always using a CVC checklist, inspecting the guidewire before and after insertion, and carefully examining the postinsertion radiographs. This checklist should be mandatory with every CVC insertion, including the perioperative period.