Materials and techniques for percutaneous retrieval of intravascular foreign bodies

The presence of an intravascular foreign body represents a well-known risk of serious complications. While in the past surgical removal of intravascular foreign body was the most common intervention, nowadays a percutaneous approach in the retrieval of an intravascular foreign body is widely accepted as the first-line technique. In the literature, many case reports describe different techniques and materials. This article summarizes and illustrates the main materials and techniques currently applied for percutaneous retrieval of intravascular foreign body, providing a simplified tool with different interventional possibilities, adaptable to different clinical situations.

Missed Central Venous Guide Wires: A Systematic Analysis of Published Case Reports

OBJECTIVE

The inadvertent loss of an entire guide wire during central venous catheterization can lead to serious patient harm and require additional investigations as well as retrieval procedures. We aimed to analyze globally published reports of lost wires during central venous catheterization to understand its possible etiology, presentation, treatment, and outcomes with an objective of finding solutions to make the procedure safer.

DATA SOURCES

MEDLINE, Scopus, and CINAHL, supplemented by scanning the reference lists of relevant publications.

STUDY SELECTION

All reports describing an inadvertent intravascular loss of a complete guide wire during placement of central venous catheters published up to December 2014 were included. Reports exclusively describing the 1) retrieval method, 2) partially retained guide wires, and 3) entrapped guide wires during withdrawal were excluded.

DATA EXTRACTION

In each instance, we collected data about the method of the missed guide wire detection, the time interval between the procedure and detection, the supplementary investigations performed to confirm the diagnosis, and the risk factors associated with such events as well as the complications, the final outcome, and the wire retrieval methods used.

DATA SYNTHESIS

A systematic analysis of the accessed publications was performed.

CONCLUSIONS

Over the last decade, the number of reported instances of lost guide wires during central venous catheterization has increased rapidly. Unsupervised or improperly supervised insertions of the central catheters by trainees, distractions during insertions, and high workload are the main risk factors. A retained guide wire increases the risk and cost of additional diagnostic and therapeutic interventions, as well as imposing many minor-to-serious life-threatening complications. Continuing education along with simulator-based skill development, vigilant supervision, and a shared workload during out of hours working are likely to prevent such occurrences.

Intravascular foreign bodies: what the radiologist needs to know

The intravascular foreign bodies (IFBs) can originate from many sources both iatrogenic and noniatrogenic; as the frequency of endovascular therapies increases, the incidence of lost or embolized iatrogenic foreign bodies is also increasing. As IFB can cause significant complications such as thrombosis, pulmonary and peripheral embolism, etc. It is therefore necessary to remove them, and this may be accomplished through surgery or by means of percutaneous radiologic techniques. Percutaneous approach is widely perceived as the best way to retrieve IFB. We provide an overview of recent literature, clarifying what devices are being lost, what symptoms occur as a result, and how retrieval is being performed.

Successful removal of kinked J-guide wire under fluoroscopic guidance during central venous catheterization -A case report-

Guidewire-associated complications that occur during the process of central venous catheterization include its kinking, looping, knotting and breakage. The removal of a looped or knotted guidewire is problematic because it can cause vessel damage, major hemorrhage, or embolization of a fractured guidewire. We report a case of guidewire kinking and its successful removal under fluoroscopic guidance.

[Sticking guide wire. Problems with a high-flow catheter]

In the case presented an intravenous line for large volume infusion rates was to be placed in a patient with an aortic aneurysm during clinical preoperative care. After a high-flow catheter had been placed without any problems retraction of the guide wire was found to be impossible. Computer tomography revealed that the reason was a kink in the catheter resulting in the guide wire being nipped off. Fortunately both catheter and guide wire could be removed completely without any further complications.