Medical University of Gdansk, Poland: Department of Nephrology, Transplantation and Internal Medicine.
Medical University of Gdansk, Poland: Department of Internal and Pediatric Nursery.
Pol Merkur Lekarski. 2021 Apr 18;49(290):143-145.
Hemodialysis is the dominant method of renal replacement therapy. The condition of its effectiveness is obtaining adequate vascular access, among others, central catheters. Central venous catheterization is a routine procedure, but it carries a risk of complications. An extremely rare but completely avoidable complication is the loss of the guidewire during the central venous catheterization procedure.
A 79-year-old patient, chronically hemodialyzed was admitted to the hospital to create vascular access. Previous vascular access, femoral central venous catheter was removed due to thrombosis. During hospitalization, angio-CT scan was performed, which showed the presence of a foreign body in the venous system, from the inguinal canal to the brachiocephalic vein. This structure turned out to be a guide, remaining after vein catheterization in the past. Complications during the procedure have never been reported. While bending her torso, the patient has been complaining of nonspecific pains in the neck area for 2 years. Part of the guide was extravascular in the upper mediastinum. The patient was consulted by a vascular surgeon, who due to the presence of the guidewire for a long time, recommended conservative treatment and regular follow-ups.
An extremely rare complication, which is the loss of the guide during insertion of a vascular catheter, can be avoided by strict adherence to procedures, mindfulness, occupational hygiene and by appropriate supervision of specialists over young doctors. The presented case of the patient proves that the guidewire left in the venous system may remain unnoticed for several years. In the described case, removal of a foreign body would be associated with extensive surgery and a high risk of vascular damage, therefore conservative treatment and regular check-ups were recommended.
血液透析是肾脏替代治疗的主要方法。其有效性的条件之一是获得足够的血管通路，包括中央导管。中心静脉置管是一种常规操作，但存在并发症的风险。一种极其罕见但完全可以避免的并发症是在中心静脉置管过程中导丝丢失。
一名 79 岁的患者，长期接受血液透析，因血栓形成而被收治入院以建立血管通路。先前的血管通路，股静脉中央导管已被移除。住院期间，进行了血管造影 CT 扫描，显示静脉系统中有一个异物，从腹股沟管到头臂静脉。该结构原来是过去静脉置管后遗留的导丝。该过程中从未报告过并发症。当患者弯腰时，她已经在颈部区域抱怨了 2 年的非特异性疼痛。导丝的一部分在中上纵隔外血管。血管外科医生对患者进行了会诊，由于导丝存在时间较长，建议采用保守治疗和定期随访。
一种极其罕见的并发症，即在插入血管导管时导丝丢失，可以通过严格遵守程序、注意、职业卫生以及适当监督年轻医生来避免。该患者的病例证明，静脉系统中遗留的导丝可能在数年内都不会被发现。在描述的病例中，移除异物将与广泛的手术和血管损伤的高风险相关，因此建议采用保守治疗和定期检查。
