Yang Hee Chul, Nisivaco Sarah, Kurihara Chitaru
Division of Thoracic Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Chest Surg. 2025 Jul 5;58(4):157-159. doi: 10.5090/jcs.25.023. Epub 2025 Jun 4.
The incidence of a missing guidewire during the Seldinger technique is low but can occur due to procedural errors. Reported rates vary, ranging from 0.1% to 0.8% in central venous catheterization and other vascular access procedures. We present a rare case of a retained guidewire within a pulmonary bulla following Seldinger-based chest tube insertion in a patient with ventilator-induced pneumothorax. Due to a prolonged air leak, the guidewire was removed, and wedge resection of the affected lung parenchyma, along with talc pleurodesis, was performed via video-assisted thoracoscopy. Closed thoracostomy using the Seldinger technique requires caution in emphysematous patients receiving mechanical ventilation. To facilitate lung deflation and minimize the risk of lung injury during needle and guidewire placement, the endotracheal tube can be temporarily disconnected from the ventilator. Over-insertion of the wire and dilator should be avoided. Supervision and simulation training are crucial to prevent this type of "never event."
在塞丁格技术操作过程中导丝丢失的发生率较低，但可能因操作失误而发生。报道的发生率有所不同，在中心静脉置管及其他血管通路操作中，发生率为0.1%至0.8%。我们报告了1例在为1例呼吸机相关性气胸患者行基于塞丁格技术的胸管置入术后，导丝残留在肺大疱内的罕见病例。由于漏气时间延长，取出了导丝，并通过电视辅助胸腔镜对受累肺实质进行楔形切除及滑石粉胸膜固定术。在接受机械通气的肺气肿患者中，采用塞丁格技术进行闭式胸腔造口术时需要谨慎。为便于肺复张并将置针和导丝过程中肺损伤的风险降至最低，可将气管导管暂时与呼吸机断开。应避免导丝和扩张器过度插入。监督和模拟训练对于预防这类“零失误事件”至关重要。
