Missing Guidewire in a Bulla: A Case Report.

Area of Science:

• Thoracic Surgery
• Interventional Pulmonology
• Medical Device Safety

Background:

• The Seldinger technique is widely used for vascular access, including chest tube insertion.
• Procedural errors can lead to complications, such as retained guidewires, although rare.
• Mechanical ventilation and underlying lung disease increase procedural risks.

Observation:

• A case of a retained guidewire within a pulmonary bulla after Seldinger-based chest tube insertion in a patient with ventilator-induced pneumothorax is presented.
• The retained guidewire was associated with a prolonged air leak.
• Surgical intervention including wedge resection and talc pleurodesis was required.

Findings:

• Retained guidewire in pulmonary bulla is a rare complication of Seldinger technique for chest tube insertion.
• Mechanical ventilation and emphysematous lung disease increase the risk of guidewire misplacement.
• Specific precautions, such as temporary ventilator disconnection, are advised during guidewire manipulation.

Implications:

• Emphasizes the need for meticulous technique and heightened caution when performing Seldinger-based procedures in mechanically ventilated patients with lung disease.
• Highlights the importance of operator training, supervision, and simulation to prevent rare but serious "never events".
• Suggests potential modifications to the Seldinger technique to mitigate risks in high-risk patient populations.