Guidewire Removal Research Articles

Single- and Multiple-Segment Percutaneous Pedicle Screw-Rod Fixation: Complications and Bailout Strategies

Percutaneous pedicle screw fixation systems have improved significantly since their introduction in 2001. A new surgeon’s learning curve is usually 70 cases when defined by the complication rate and not by a specific time to insertion. An appropriate preoperative assessment is important when considering a percutaneous pedicle screw approach, and high complication rates are linked to patients above the age of 65 and the need for multilevel fixation. A surgeon should be wary of performing surgery at the wrong site; therefore, meticulous documentation should be carried out, and the operative level should be confirmed. During surgery, attention should be paid to positioning the patient and varying the location of the skin incision depending on the patient’s obesity. Penetration of visceral structures and vessels due to guidewire insertion is not an uncommon complication. Anterior penetration of the guidewire by as little as 5 mm can cause significant sympathetic chain dysfunction. Guidewire removal should also be prevented during tapping of the screw hole and removal of the Jamshedi needle. This procedure has a high complication rate in unexperienced hands and should be performed by surgeons after adequate cadaver training. Surgeons should initially attempt only single-level fixations and then later on move to more complex multilevel fixations and deformity corrections.

Retained peripherally inserted central catheter guidewire with vegetation.

Sir, Central venous cannulation is often a necessity for patients in intensive care units or in patients with difficult peripheral access. Loss of the guidewire is a serious and potentially life-threatening complication with reports of fatalities in up to 20% of cases, when the complete guide wire is lost.[1] A 2-year 3-month-old female child presented to our institute with chief complaints of poor weight gain, abdominal discomfort, and decrease in appetite. Chest X-ray of the patient showed a radio-dense wire extending into inferior vena cava (IVC) and right atrium [Figure 1]. Patient had a history of hospital admission at the age of 8 months for jaundice. Peripherally inserted central catheter (PICC) was inserted at that hospital in right femoral vein due to difficult peripheral venous cannulation. PICC line was kept for 12 days and later it was removed. Later on, patient presented to our institute with above mentioned complaints. Computerised tomography (CT) scan showed evidence of a linear radio-dense wire extending from infrarenal IVC into the right ventricle. Its tip was seen in the superior vena cava suggestive of foreign material [Figure 1b]. Transthoracic echocardiography showed a hyperechoic mobile structure of size 20 × 10 mm (possibly a vegetation) in the right atrium having attachment to the superior vena cava and IVC with to-and-fro movement across tricuspid valve and near total occlusion of IVC by hyperechoic structure till mid abdomen level [Video 1]. Moderate to severe tricuspid regurgitation (TR) was seen on transthoracic echocardiography. Surgical removal of PICC guidewire was planned. Complete blood count, serum electrolytes, coagulation profile, liver, and kidney function tests were done preoperatively. Preoperative electrocardiogram showed sinus tachycardia and nonspecific ST-T wave changes. The open surgical repair was planned under hypothermic cardiopulmonary bypassFigure 1: (a) Chest X-.Ray PA view showing a radio dense wire extending into inferior vena cava and right atrium. (b) Computerised tomography scan showing evidence of a linear Ra: Right atrium dense wire extending from infrarenal IVC, extending into right ventricle and the tip is seen in superior vena cava suggesting foreign material. (c) Guidewire with vegetation. (d) Right atrium opened with blocked IVC. IVC: Inferior vena cava {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Clip 1","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_0bc3rv32"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Patient was induced with general anaesthesia and endotracheal intubation carried out after injecting fentanyl 5 mg/kg, midazolam 0.1 mg/kg, and vecuronium 0.1 mg/kg. Five lead electrocardiogram, invasive arterial blood pressure, central venous pressure, temperature, end tidal carbon dioxide, pulse oximetry, and urine output were monitored intraoperatively. Cardiopulmonary bypass (CPB) was established after cannulating ascending aorta and right atrium. Total circulatory arrest was initiated. Right atrium was opened and removal of guidewire with vegetation from right atrial wall and tricuspid valve leaflet were done [Figure 1c and 1d]. Tricuspid valve was checked for tricuspid regurgitation and anteroseptal commissuroplasty was done. Post repair, moderate to severe tricuspid regurgitation was present. CPB was instituted again, and tricuspid valve was repaired. After complete rewarming, patient was weaned off CPB uneventfully. 180 ml of packed red blood cells was transfused intraoperatively. Total duration of surgery was four hours. Patient was shifted to paediatric intensive care unit and was extubated on second postoperative day. Complications pertaining to the retained guide wire include complete loss of wire, injury to the vessel from the wire, fracture of the wire, and bleeding.[1–5] Patients undergoing foreign body removal pose a challenge for the anaesthesiologist as there can be risk of arrhythmia, bleeding causing haemodynamic instability, prolonged aortic cross clamp time, and postbypass myocardial dysfunction. Percutaneous retrieval was not possible in this case due to the extent of guide wire with associated vegetation and risk of its embolisation. Therefore, decision was made for surgical plan to remove guide wire under cardiopulmonary bypass. This case highlights the importance of formulating a plan for the anaesthetic management of patients undergoing guidewire removal and preparedness for postoperative management. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Case of Celphos Poisoning with Retained Guide wire Posted for Emergency OT for Guide Wire Removal

Case of Celphos Poisoning with Retained Guide wire Posted for Emergency OT for Guide Wire Removal

Evaluation of a diluted lipid emulsion solution as a lubricant for improved peripherally inserted central catheter guidewire removal in a neonatal population.

BackgroundMedical management of neonates is often established upon safe and reliable vascular access, frequently utilized to provide physiological monitoring, parenteral and supportive treatments, and diagnostic and/or procedural purposes. For this, peripherally inserted central catheters (PICCs) are often used to provide safe vascular access and infusion-related therapies in the neonatal intensive care (NICU) setting.PurposeDifficult PICC guidewire removal is understood to cause catheter damage, causing luminal rupture or possible breakage of the catheter or guidewire itself. The aim of this study was to assess and compare the incidence of therapy failures with use of a preflush fluid using normal saline (NSS) versus a diluted lipid solution (DLS) prior to device insertion, to assist with guidewire removal and prevent unnecessary catheter damage.Method and settingA retrospective, observational study was performed in the Neonatal Intensive Care Unit (NICU) of the Women’s Wellness and Research Centre, Hamad Medical Corporation, Qatar. This single site study included 507 neonates who required intravenous therapy administered via a PICC during the study period.ResultsResults demonstrated the use of a diluted lipid solution preflush (DLS) resulted in significantly lesser failures, when compared with the control group (NSS). This highlights a clinical significance after adjusting for day of insertion, gestational age, birth weight and catheter type.ConclusionDLS preflush demonstrated a benefit over the use of a NSS preflush to enhance PICC guidewire removal in neonatal patients in the NICU. The risk for development of maintenance-related complications leading to premature device removal decreased significantly if the DLS preflush was used. During the study period, no complications related to the use of a lipid preflush solution were identified.Implications for practice and researchThis may be the first study published investigating and supporting guidewire removal enhancement by using a diluted lipid/saline preflush solution. When the requirement for vascular access is most pertinent in the neonate, using a diluted lipid preflush may provide an effective method to assist in guidewire removal to prevent malposition and vascular device complications in the neonatal population.

A case report of fractured guidewire removal by rotational atherectomy

BackgroundFractures occur in association with manipulation and because of the complexity of the coronary artery, and they can cause a series of serious complications, such as myocardial infarction and secondary thrombosis. Common treatments for fractured guidewires include conservative, interventional and surgical methods.Case presentationsA 67-year-old male was admitted to our institute. He had recurrent chest tightness and chest pain for half a month, which worsened in one day. He was diagnosed with acute non-ST-segment elevation myocardial infarction. Guidewire fracture was caused by improper manipulation during percutaneous coronary intervention. We successfully performed rotational atherectomy to remove the fractured guidewire. His symptoms, and condition improved 6 weeks after the removal of fractured guidewire.ConclusionPhysicians should have higher requirements for the quality of the guidewires and operation techniques.

Guidewire knot formation with peripherally inserted central catheter.

The formation of guidewire knots during PICC insertion is an extreme rare complication. Forced insertion or withdrawal of a knotted guidewire may cause tearing of the veins. Surgical guidewire removal is required due to risk of vascular injury.

Influence of guide wire removal on tip location in peripherally inserted central catheters (PICCs): a retrospective cross-sectional study

ObjectivesThe aim of this study was to identify the prevalence of peripherally inserted central catheter (PICC) malposition and the influence of guide wire removal on tip location in PICCs and...

P4526Implant procedure and lead handling characteristics of a novel active fixation quadripolar lead: Results from the Attain Stability Quad clinical trial

Abstract Background Dislodgements of left ventricular (LV) leads are still a challenging problem in cardiac resynchronization therapy (CRT). The Attain Stability Quad (ASQuad) MRI SureScan 4798 steroid-eluting, quadripolar LV lead has a side-helix to enable the lead to be actively fixated to the vessel wall. The uniquely designed active fixation can be advantageous in vessels that are wide or have short take-offs. Further, the helix easily elongates to allow for future extraction. Purpose To report on the handling, performance and safety of ASQuad LV lead in a large clinical study. Methods The ASQuad clinical study is a prospective clinical trial from 50 centers in 10 countries enrolling CRT candidates implanted with the ASQuad LV lead. Aside from evaluating safety and effectiveness of the LV lead, the trial specifically collected data on parameters related to lead stability during and post implant. Results Of 440 enrolled patients (74.8% male, average age 70±11 years) that underwent an implant attempt, 426 (96.8%) were successfully implanted. The helix was mostly affixed in the mid to basal lateral position (62%), followed by mid to basal posterior position (29%). The lead tip placement was most often mid lateral or mid posterior (77%), and in a vein with diameter greater than the pacing electrode diameter (>5.1 French) in the majority (60%) of procedures. Among all subjects (n=421) who underwent pacing capture thresholds (PCT) tests before and immediate after guide catheter slitting, 98% reported ≤1 V difference in PCT, and 86% were within 0.5 V. The interquartile range for the difference in PCT was −0.1 to 0.1 V. The mean PCT at implant for all subjects at the final selected LV pacing vector was 1.15±0.70 V at 0.5 ms pulse width. The average LV lead implant time was 16±21 minutes. Targeted pacing location was achieved in 97% of successful implants, and 98% of implanters reported good or fair stability after guidewire removal. The overall handling of the LV lead was rated as acceptable by implanters in 99% of cases. Three patients (0.7%) experienced LV lead dislodgement post implant, and these complications were resolved by repositioning of the lead (0 and 1-day post implant) in two and by lead replacement when noted at 90 days follow-up in one. Conclusions The ASQuad LV lead was implanted with a high rate of success and ability to achieve the targeted pacing location. Lead handling and stability following guidewire removal were rated as acceptable by nearly all implanters. The side-helix likely improved LV lead stability since 98% of the subjects had ≤1 V difference in PCT before and after catheter slitting during implant procedures, and by demonstrating a low post implant lead dislodgement rate. Acknowledgement/Funding Sponsored by Medtronic

Intraoperative contrast-enhanced ultrasound for early diagnosis of endoleaks during endovascular abdominal aortic aneurysm repair

BackgroundThe aim of this study was to evaluate the feasibility and utility of intraoperative contrast-enhanced ultrasound (CEUS) for early detection of endoleaks (ELs) during endovascular abdominal aortic aneurysm repair (EVAR) compared with completion digital subtraction angiography. MethodsPatients undergoing elective EVAR from January 2017 to April 2018 were consecutively enrolled in this prospective study. After endograft deployment, two-digital subtraction angiography (2DSA) with orthogonal C-arm angulations (anteroposterior and sagittal view) were routinely performed. After the endovascular treatment of clear, high-flow type I/III ELs detected by 2DSA, intraoperative CEUS was carried out in sterile conditions on the surgical field before guidewire removal. Presence and type of EL were evaluated with 2DSA and CEUS. CEUS was performed with the vascular surgeon blinded to the 2DSA findings. The primary end point was the level of agreement between 2DSA and CEUS to detect any type of EL and type II EL. Agreement between two diagnostic methods was calculated using Cohen's kappa. The secondary end point was utility of CEUS for intraoperative adjunctive procedure guidance. ResultsSixty patients were enrolled (mean age, 78 ± 6 years; 90% male). 2DSA revealed 11 ELs (18%; 1 type IA, 10 type II), and CEUS 25 ELs (42%; 2 type IA, 23 type II). 2DSA and CEUS were in agreement in 39 cases (65%; 32 no ELs, 7 type II ELs). CEUS detected 17 ELs not identified by 2DSA (28%; 2 type IA, 15 type II); 2DSA detected three ELs not identified by CEUS (5%; 3 type II). In one case, 2DSA and CEUS detected type II and type IA ELs, respectively. For EL and type II EL detection, Cohen's kappa was 0.255 and 0.250, respectively (both “fair agreement”). Intraoperative adjunctive sac embolization was performed under CEUS control in 4 cases and technical success was 100%. ConclusionsIntraoperative CEUS during EVAR is feasible and can detect a greater number of ELs than 2DSA, in particular type II ELs. Further studies are necessary to assess the reliability of this intraoperative diagnostic examination. In type II ELs, CEUS may represent an additional, useful tool for intraoperative sac embolization guidance.

IP009. Intraoperative Contrast-Enhanced Ultrasound for Early Diagnosis and Treatment of Endoleaks During Endovascular Abdominal Aortic Aneurysm Repair∗

The objective of this study was to evaluate the feasibility of intraoperative contrast-enhanced ultrasound (CEUS) to detect and to treat endoleaks (EL) during endovascular aneurysm repair (EVAR). Patients undergoing elective EVAR from January to December 2017 were consecutively enrolled. After endograft deployment, two completion angiography studies (2CAs) with orthogonal C-arm angulation (anteroposterior and 90-degree left anterior oblique) were routinely performed. Intraoperative CEUS was performed in sterile conditions on the surgical field before guidewire removal. Presence and type of EL at the 2CAs and CEUS were evaluated and prospectively collected. CEUS was performed by a vascular surgeon blinded to the findings of the 2CAs. The primary end point was the agreement between the 2CAs and CEUS for detection of any EL and type II EL (Cohen κ). The secondary end point was evaluation of number and type of intraoperative adjunctive procedures performed as a result of CEUS findings. Forty-four patients were enrolled (mean age, 77 ± 6 years; male, 91%). The 2CAs revealed 9 ELs (21%; type IA, 1; type II, 8; Table), and CEUS revealed 18 ELs (41%; type IA, 2; type II, 16; Fig). The 2CAs and CEUS showed the same findings in 28 cases (64%; no EL, 23; type II EL, 5). CEUS detected 12 ELs unidentified by the 2CAs (27%; type IA, 2; type II, 10). The 2CAs discovered three ELs unseen at CEUS (7%; type II, three). For EL and type II EL detection, Cohen κ was 0.236 and 0.175, respectively. On the basis of CEUS findings, adjunctive intraoperative procedures were performed in five patients (11%): Palmaz stent was deployed for a type IA EL in one case; sac embolization with coils was performed under CEUS control in four cases according to the preoperatively planned procedure. Intraoperative CEUS during EVAR detected a higher number of ELs than the 2CAs and allowed more precise identification of EL type. CEUS is a useful tool in intraoperative sac embolization for type II EL.TableEndoleaks (ELs) detected with two completion angiography studies (2CAs) and contrast-enhanced ultrasound (CEUS) in 44 patientsCEUSTotal+−2CAs+639−122335Total182644 Open table in a new tab

Complicated Central Line Placement in a Patient With IVC Filter

SESSION TITLE: Fellow Case Report Poster - Critical Care II SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: In the acute care setting central venous catheters’ play a vital role in the treatment and monitoring of critically ill patients. The use of central venous catheters is associated with adverse events that are both hazardous to patients and expensive to treat. Mechanical complications are reported to occur in 5 to 19 percent of patients. and dislodging IVC filter is a possible complication CASE PRESENTATION: 73 year old female with past medical history of DVT s/p IVC filter and multiple other comorbidities who presented to the emergency department with altered mental status, sepsis and respiratory failure. Right IJ line was attempted for volume resuscitation and administration of life saving medications. During cannulation of catheter good blood return was noted on first attempt and the guide wire was advanced. During advancement of the guide wire it was noted that it was met with no resistance and the physician continued to feed the guide wire almost in its entirety. Upon removing the guide wire, the attending physician noted resistance and was unable to safely remove the guide wire. Imaging later revealed that the guide wire was actually lodged into the IVC filter. A second IV access was established, while a dedicated staff member monitored the guide wire closely Interventional radiology was called and patient was taken for guide wire removal under fluoroscopy. Intraoperative imaging revealed the J portion was wedged into the apex of the Greenfield filter. A long 6 French dilator had to be used to dislodge the guide wire from the filter. DISCUSSION: The majority of complications associated with central line placement is mechanical and user dependent. The use of ultrasound has significantly reduced the number of adverse events associated with line placements. In this case, inserting the guide wire too far could have caused significant morbidity. This can be avoided by shortening the length of the guide wire, in turn limiting the distance it can be advanced to 16-20 cm. CONCLUSIONS: Marking the length from the J end of the guidewire by manufacturing companies can help physicians avoiding overinserting the guidewire and avoid complications. Reference #1: Preventing Complications of Central Venous Catheterization D McGee, M Gould. N Engl J Med 2003; 348:1123-1133March 20, 2003DOI: 10.1056/NEJMra011883 Reference #2: Guidewire Dislodgment of Inferior Vena Cava Filters During Insertion of Central Venous Catheters S Kang, M Borge, M Mansour, N Labropoulos, W Baker VASC ENDOVASCULAR SURG September 1997 31: 587-593, DISCLOSURE: The following authors have nothing to disclose: Mohammad Taleb, Ramzyah Kaid, Abdulmonam Ali No Product/Research Disclosure Information

Open Wide: Transient Wide-Open Mitral Regurgitation During Transcatheter Aortic Valve Implantation

An 87-year-old woman underwent transcatheter aortic valve implantation (TAVI) for severe aortic stenosis via the transfemoral approach. Pre-procedural mitral regurgitation (MR) (​(A,A, Online Video 1) was mild. During guidewire positioning across the aortic valve, the MR was unchanged (​(B,B, Online Video 2). After balloon valvuloplasty, the MR increased in severity (C and D, Online Videos 3 and ​and4).4). Subsequent continuous-wave Doppler demonstrated wide-open MR flow with a triangular-shaped spectral envelope confirming rapid pressure equalization (​(E).E). Three-dimensional echocardiography revealed noncoapting mitral valve leaflets and wire impingement (arrow) of the chordae (F and G, Online Videos 5 and ​and6).6). With guidewire removal, the severe MR resolved (​(H,H, Online Video 7). Wire impingement of the mitral valve apparatus, causing the leaflets to “open wide” with transient severe MR, can occur during any portion of the TAVI procedure and must be monitored closely for early recognition and procedural modification. LA = left atrium; LV = left ventricle. Online Video 1 Online Video 2 Online Video 3 Online Video 4 Online Video 5 Online Video 7

Guidewire retention following central venous catheterisation: a human factors and safe design investigation.

Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.

Guidewire localization by transthoracic echocardiography during central venous catheter insertion: a periprocedural method to evaluate catheter placement

To evaluate the feasibility of guidewire detection in right cardiac cavities by transthoracic echocardiography (TTE) in order to detect catheter misplacement and to optimize central venous catheter (CVC) positioning. Ultrasonic control for catheter tip positioning was compared to that by chest X-ray (CXR). We conducted a monocentric prospective observational study (January-November 2010). All consecutive patients undergoing CVC insertion were included. The puncture was performed using the landmark method or ultrasound guidance. TTE was performed during the procedure to follow the arrival of the guidewire in the right cardiac cavities. Catheter misplacement was defined as an aberrant position on the postprocedural CXR (catheter positioning in ipsilateral or contralateral veins). The primary endpoint was the prediction of catheter misplacement by guidewire detection in the cardiac cavities. The secondary endpoint was the optimization of the catheter tip placement in the superior vena cava. A total of 98 patients received 101 CVC. The guidewire was visualized in 92 cases. In five cases, the guidewire was not seen in the right cardiac cavities and CXR showed catheter misplacement. In four cases, poor echogenicity led to the ultrasound examination being abandoned. Catheter misplacement was detected by TTE with a sensitivity of 96% (CI 90-98%), a specificity of 83% (CI 44-97%), a positive predictive value of 98%, and a negative predictive value of 55%. Likelihood ratios were LR+ 5.7 (CI 0.96-34.4) and LR- 0.05 (CI 0.02-0.14). Guidewire removal under TTE avoided an excessively distal position of the catheter tip in all cases. TTE is a reliable tool to detect catheter misplacement and to optimize catheter tip positioning during the procedure of CVC insertion.

Acute Mitral Regurgitation during Transapical Aortic Valve Implantation: Usefulness of Intraprocedural Transesophageal Echocardiography

Mini‐AbstractWe report a case of acute mitral regurgitation due to a temporary distortion of the mitral valve apparatus during apical transcatheter aortic valve implantation (TAVI). A few minutes after penetrating the apex, the patient developed severe hypotension and cardiac arrest. A hemodynamic support with femoral–femoral extracorporeal circulation was immediately installed. Transesophageal echocardiography (TEE) revealed that the guidewire interfered with the subvalvular mitral apparatus generating severe acute mitral regurgitation. The patient's condition improved immediately after guidewire removal and there was no residual mitral regurgitation. This case clearly shows the importance and the usefulness of performing a thorough and complete TEE monitoring to prevent and identify complications.

Removal of knotted dialysis guide wire under monitored anaesthesia care in radiological suite

Sir, Double lumen femoral catheterization (DLFC) is utilized for emergency dialysis.[1] Complications such as looping, knotting, vascular perforation, fragmentation and displacement of the guide wire are encountered frequently.[2] We describe a case wherein there was knotting of guide wire during insertion of DLFC, not amicable to removal and needed removal under anesthesia in the radiological suite. A DLFC insertion was planned for dialysis of a 70-year-old man as the arterio-venous fistula was not working properly. Right-sided femoral vein was cannulated and guide wire inserted. The initial path of the guide wire was smooth but thereafter a resistance was felt. The guide wire was pushed in further with some force till no further insertion was possible. The operator then tried to pull the guide wire back by gentle traction but it was stuck. A swelling appeared at the site. He left the guide wire in position, applied pressure dressing. X-ray pelvis region showed that the guide wire had multiple loops and entanglement [Figure 1].Figure 1: X-ray pelvis showing the entangled guide wire with formation of loop and knotThe patient was shifted to the catheterization laboratory for fluoroscopic-assisted guide wire removal. The knot of the guide wire tightened when gentle traction was applied for pulling it out. A 3-cm incision was made near the puncture site, followed by securing of the proximal vein with stay suture. A 7Fr femoral sheath dilator was inserted over the guide wire to dilate the subcutaneous tract of entry point. Over this 8Fr femoral sheath was inserted up to the point of the knot. Attempts to take the sheath distal to the knot failed. A 7Fr renal guiding catheter was inserted over the guide wire up to the point of the loop. The wire was pushed further proximal in the vein, distal to the knot, to get space for untying of the knot. A gentle traction was applied which led to the removal of the guide wire [Figure 2].Figure 2: Disentangling of knot and loop of the guide wireCatheter-related complications are well known, but there are few reports in which a guide wire has been involved. Common guide wire-related complications reported are entrapment of guide wire in the sternomastoid muscle[34] and in inferior vena cava filters.[5] Dialysis catheter is often placed by personnel who are in training; closer supervision by a more senior person may help identify and prevent similar complications. The experience of an operator has direct bearing on the number of complications. Insertion of a catheter by a physician, who has performed 50 or more catheterizations, is half as likely to result in mechanical complications.[6] A direct relation is there between the number of attempts of insertions and mechanical complications.[7] After the occurrence of this complication, we made some changes in the dialysis catheter insertion protocol. In case of more than three attempts at insertion, the operator should seek help rather than continue the procedure. Force should not be applied during insertion/withdrawal of the guide wire. Any resistance felt should prompt removal of needle and guide wire en-bloc.

Broken Kirschner or Guide-Wire Retrieval: A Report of 4 Cases

Migration of a broken wire into the hip joint or pelvis during surgery is rare, but it can cause significant complications. Retrieval can be extremely difficult and hazardous. We report 4 cases of broken Kirschner or guide wire removal around the hip joint. Two wires were inside the hip joint and two had protruded into the pelvis. The problems encountered and techniques used for retrieval are discussed.

Successful Thoracoscopic Resection of Pulmonary Metastasis Less Than 1 cm in Size Utilizing Preoperative CT-Guided Wire Localization

Preoperative computer tomography (CT) guidance localization utilizing a percutaneous guidewire before thoracoscopic resection is safe and beneficial in children with pulmonary nodules less than 1 cm in size or located deep in the pleural surface. This paper describes a successful thoracoscopic resection of a little subpleural pulmonary metastasis of a Wilm's tumor in a 5-year-old child utilizing preoperative CT-guided wire localization of the lesion. The thoracoscopic procedure was performed with the use of two ports, the nodule was easily localized,and the pulmonary wedge resection was made by the use of an endo-GIA linear stapling device after guidewire removal. The operating time was 45 minutes and the chest tube was removed after 48 hours. The postoperative course was uneventful, and the child was discharged on postoperative day 5. This technique allows the surgeon to resect little pulmonary nodules, avoiding the need of more invasive procedures as standard thoracotomy without adjunctive morbidity and with good cosmetic results.

Shearing of a Peripheral Nerve Catheter

Shearing of a Peripheral Nerve Catheter

Preventing guide wire removal during intramedullary reaming

Preventing guide wire removal during intramedullary reaming