“There was difficulty in inserting the guidewire beyond 4 cm, and hence we decided to redo the procedure. When we started pulling out the guidewire, we could bring out approximately 2.5 cm of it and the distal 1.5 cm remained inside. Another attempt of retrieving the guidewire was made but failed as it remained stuck inside the vein. We then involved a paediatric surgeon, who gradually pulled the wire, and the vein along with the entangled wire was pulled out of the insertion point. The surgeon ligated this vessel and removed the guidewire to visualise a knot at the tip of the wire . Probably the guidewire had got stuck in a small vein above the jugular vein with a knot formation which resulted in non-advancement of it further in the jugular vein as well as difficulty in withdrawing it fully out of the point of insertion.”Reference:
Agarwal A, Agarwal A, Goyal P. Knotted J tip guidewire during central venous catheterisation in an infant. Indian J Anaesth. 2022 Dec;66(12):878-879. doi: 10.4103/ija.ija_657_22. Epub 2022 Dec 20. PMID: 36654890; PMCID: PMC9842080.