Presentation
Lost arterial line guide wire (ICU patient with Covid-19)
Patient Data
~15 cm linear metallic radiopacity projected within the soft tissues of the radial aspect of the left forearm consistent with a retained guide wire in the radial artery.
Case Discussion
Losing the guidewire in arterial and central venous cannulation procedures on the critical care unit is a rare but well-recognized complication of these commonly-performed procedures. It is an entirely avoidable complication as long as there is a strict adherence to meticulous Seldinger technique. In particular, the operator is responsible to maintain a hold on the proximal end of the guidewire as long as it is in the blood vessel.
Signs that the guidewire is lost include 3:
- guide wire cannot be found during/end of the procedure
- resistance to injection via the distal lumen
- poor venous backflow from the distal lumen
- follow-up radiograph shows a retained guidewire
Intravascular misplacement of a guidewire is a - fortunately - rare complication, and there is little published data on its complication rate. Embolism of a fragment of guidewire may be catastrophic but in most cases the complete wire is lost and patients remain asymptomatic. In theory though such a lost guidewire could produce serious sequelae if it reached the heart such as dysrhythmias, vessel trauma, and/or thromboembolism. Therefore it is important to retrieve the guidewire ASAP. Fortunately, modern IR techniques mean that retrieval of a lost guidewire is achievable in most cases 3.