|Year : 2014 | Volume
| Issue : 2 | Page : 106-108
Migrated guide wire during femoral vein catheterization
Hatem O Qutub
Department of Internal Medicine, College of Medicine, University of Dammam, Dammam, Saudi Arabia
|Date of Web Publication||18-Jul-2014|
Hatem O Qutub
Associate Professor of Medicine and Critical Care, Consultant Intensivist Pulmonologist, University of Dammam, King Fahd Hospital of the University, P.O. Box: 40133, Al-Khobar 31952
Central venous line catheterization is the main route for therapeutic intervention in critically ill patients. Despite the relatively common complications, the femoral vein is a standard route for catheterization. This is a case report of a rare preventable complication of migration of the guide wire and catheter from the femoral vein through the systemic circulation in a 75-year-old critically ill man in a university hospital in Saudi Arabia.
تعتبر القسطرة الوريدية الطريق الرئيسي للتدخل العلاجي لدى المرضى المصابين بأمراض خطيرة. وبالرغم من المضاعفات النسبية فإن الوريد الفخذي يعد المسار المعياري للقسطرة الوريدية.
تعنى هذه الحالة بإحدى المضاعفات النادرة لمريض في حالة حرجة والتي أدت إلى انتقال السلك الدال والقسطرة من الوريد الفخذي إلى جهاز الدورة الدموية.
Keywords: Femoral vein, guide wire migration, intensive care unit, Saudi Arabia
|How to cite this article:|
Qutub HO. Migrated guide wire during femoral vein catheterization. Saudi J Med Med Sci 2014;2:106-8
| Introduction|| |
Femoral vein catheterization is often used as line for resuscitation in critically ill patients. This route is associated with higher incidence of potential complications that include infection, thrombosis, hematoma and embolism.  Rare preventable complications such as migration of the guide wire or catheter tip fracture may occur and lead to major sequelae if they are not dealt with timely and properly.  Post code femoral line insertion which was complicated by migration of the guide wire into the systemic circulation is reported. This is a very rare complication that is due to a human error and is totally preventable if the procedure is performed by a skilled operator observing the standards for inserting a central vein catheter. 
| Case Report|| |
A 75-year-old man was admitted to the male medical ward of King Fahd Hospital of the University, Al-Khobar, Eastern Province, Kingdom of Saudi Arabia. He was transferred from another hospital after 2 weeks of treatment for aspiration pneumonia. He is a known diabetic on oral hypoglycemic drugs and has been almost bed bound after suffering a right hemispheric stroke with a dense left hemiplegia 6-month prior to admission. On the following day of admission he was found unresponsive, cyanosed with intact carotid pulsations. Code was announced and the patient was intubated and shifted to the medical intensive care unit. The body temperature was 38.0°C, pulse rate 85/min, respiratory rate 24/min and blood pressure was 140/85 mm Hg. Physical examination was remarkable for a dense left hemiplegia. The lungs were full of creptitations and wheezing. The abdomen revealed mild epigastric tenderness with no organomegaly. Laboratory tests showed blood leukocyte count, 21 × 109/L; hemoglobin, 10.4 g/dL; platelets count, 283 × 109/L; blood urea,
65 mg/dL; serum creatinine, 2.1 mg/dL; serum potassium,
4 mEq/L; serum lactate dehydrogenase, 493 IU/L; serum creatine kinase, 245 IU/L; serum alkaline phosphatase, 214 IU/L; prothrombin time, 15 s; and international normalized ratio, 1.2, serum lactic acid 1.2 mg/dL. The urine analysis was positive for blood (2+) and protein (1+). Arterial blood gas showed pH 7.21, PaCO 2 75, PaO 2 285. The chest X-ray revealed bilateral diffuse infiltrate with right basal consolidation. In addition the chest radiogram disclosed guide wire migration to the right internal jugular vein [Figure 1] and [Figure 2]. Immediate surgical consultation was made but they suggested the removal by radiological intervention and thoracic surgeon will be stand-by if needed. The patient's hemodynamics remained stable next morning the guide wire was removed safely by the interventionist without any complications [Figure 3].
| Discussion|| |
Many complications have been reported during and after central venous catheterization. Insertion complications become less likely as the operator gains experience. The incidence of serious insertion complications is higher for subclavian vein and internal jugular vein cannulation than femoral vein cannulation. The most common insertion complications are local bleeding, hematoma, heart dysrhythmias, arterial puncture, hemothorax, pneumothorax, air embolism, perforation of the central vein or cardiac chamber, and pericardial tamponade.  The infection and venous thrombosis are two important and the most frequent complications, but they happen later after insertion of the catheter. Akazawa et al.  reported unrecognized migration of guide wire in jugular vein catheterization. It was incidentally recognized 56 days after catheterization on chest radiography obtained for another purpose. Our case demonstrated the guide wire migrating from the femoral vein to the jugular vein and was diagnosed on the same day of procedure as incidental finding while confirming the placement of an endotracheal tube without any complications.
It seems that these kinds of complications can be prevented by following all the guidelines for catheter insertion including the checking of the catheter tray after finishing the procedure and doing radiography at the end to evaluate the position of the catheter and its possible complications.  At present with the availability of the hand-held real-time ultrasonography, the frequency of insertion complications should be very low. Although femoral catheter insertion for emergent intervention is a simple and relatively safe procedure, it can be hazardous if it is performed without observing the basic rules of catheterization, particularly if it is done by an unskilled operator.  It is recommended that the central vein catheterization be done under direct ultrasonic visualization with a catheter length as short as possible and by a skilled person. 
| Conclusion|| |
Although insertion of femoral catheter for emergent resuscitation is relatively safe procedure, it can be hazardous if performed without considering the basic rules of catheterization, particularly if it is done by an unskilled operator. Such rare complication can be totally prevented if it is been done under direct visualization with a catheter length as short as possible and by a skilled person.
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[Figure 1], [Figure 2], [Figure 3]