Case report of a central venous catheter guidewire unraveling

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“A 68-year-old woman presented to the emergency department with severe shortness of breath and was intubated. A central line was placed after the intubation to facilitate peripheral access. A CVC guidewire unraveled during placement after getting caught on an IVC filter.” Zerkle et al (2014).

Reference:

Zerkle, S., Emdadi, V. and Mancinelli, M. (2014) It All Unraveled From There: Case Report of a Central Venous Catheter Guidewire Unraveling. The Journal of Emergency Medicine. October 1st. [epub ahead of print].

Abstract:

BACKGROUND: Inferior vena cava (IVC) filters can present challenges to emergency physicians in the process of central venous catheter (CVC) placement.

CASE REPORT: A 68-year-old woman presented to the emergency department with severe shortness of breath and was intubated. A central line was placed after the intubation to facilitate peripheral access. A CVC guidewire unraveled during placement after getting caught on an IVC filter.

WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of the complications that IVC filters can cause in the placement of CVCs. Imaging and identification of IVC filters beforehand will allow for proper planning of how to manage the case in which a filter catches on the guidewire. Simple anecdotal techniques, such as advancing the guidewire and spinning the guidewire between the fingers, can facilitate the removal of the guide wire from the IVC filter.

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