Kumar Niraj, Burman Saurav, Yadav Anuradha, Tomar Gaurav Singh
Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Oral Medicine and Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India.
BMJ Case Rep. 2018 May 23;2018:bcr-2018-224219. doi: 10.1136/bcr-2018-224219.
Central venous catheter (CVC) placement is a commonly done procedure but is associated with a few complications, and guidewire-related complications are one of them. In our case after induction of general anaesthesia, we planned to insert a CVC in the right internal jugular vein under ultrasound guidance. After the insertion of the introducer needle, when we tried to insert the guidewire, it got stuck and was neither moving forward nor in a backward direction. Too much force was not applied to remove the guidewire as it might have caused shearing of the guidewire and further complicated the picture. This problem was solved by simultaneous withdrawal of guidewire along with the needle, and on examination we found soft tissue debris lodged within the lumen which was preventing the guidewire movement in both directions. So, it is suggested that guidewire should be removed along with needle as a single unit if it is required.
中心静脉导管(CVC)置入是一种常见的操作,但会伴有一些并发症,导丝相关并发症就是其中之一。在我们的病例中,全身麻醉诱导后,我们计划在超声引导下于右侧颈内静脉置入CVC。插入引导针后,当我们试图插入导丝时,导丝卡住了,既无法向前推进也无法向后移动。由于用力过大可能会导致导丝剪切并使情况进一步复杂化,所以没有施加太大力量来移除导丝。通过同时将导丝和针一起拔出解决了这个问题,检查时我们发现软组织碎片卡在管腔内,这阻碍了导丝双向移动。因此,建议在必要时将导丝和针作为一个整体一起拔出。