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A Mislocation of Double-lumen Catheter Guidewire in Right Atrium Successfully Retrieved with Loop-wire Snaring: A
1Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. dantonos@yahoo.com.
Insights
A retained guidewire in the heart, a rare complication of central venous catheterization for hemodialysis, can be successfully retrieved percutaneously. This case highlights the importance of recognizing asymptomatic heart foreign bodies.
Area of Science:
- Cardiology
- Interventional Radiology
- Nephrology
Background:
- Central venous catheterization is increasingly used for hemodialysis access.
- A rare complication is the retention of guidewires within the heart, forming heart foreign bodies.
- This case focuses on a double-lumen catheter guidewire mislocated to the right atrium.
Observation:
- A hemodialysis patient presented with dyspnea and extremity swelling, symptoms predating catheter insertion due to underlying kidney disease.
- A chest x-ray revealed the retained guidewire, confirmed by fluoroscopy.
- The retained guidewire was asymptomatic.
Findings:
- A double-lumen catheter guidewire was successfully retrieved from the right atrium using a loop-wire snare.
- The percutaneous retrieval procedure resulted in a stable patient outcome.
- The case underscores that retained guidewires can be asymptomatic.
Implications:
- Rare intracardiac foreign body complications require prompt recognition and management.
- Percutaneous retrieval is an effective and preferred method for managing retained guidewires.
- Awareness of this rare complication is crucial for clinicians performing central venous catheterizations.
Abstract:
The increasing rate of central vascular access use especially for hemodialysis access in Indonesia carries risk of retention of the guidewire to the heart resulting in a condition known as heart foreign bodies. We described a case of mislocation of double-lumen catheter guidewire to the right atrium in a patient planned to perform hemodialysis. The patient complained of dyspnea and swelling of extremities but the symptoms had already appeared before the insertion of the catheter due to the patient's underlying kidney disease arising conclusion that the foreign bodies itself are asymptomatic. The wire was found on chest x-ray and then confirmed on fluoroscopy during the retrieval procedure. Loop-wire was used to snare the guidewire. The wire was successfully evacuated and the patient was stable. The rare nature of the condition could become a challenge in recognizing the condition. Percutaneous retrieval is the preferred management of the condition.
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