Ultrasound and fluoroscopy co-guided removal of extravascular stripped central line guidewire fragments

Abstract

Inadvertent retention of guidewire is an infrequent but well recognized complication with central line insertion and other interventional procedures. The fragment can either embolize within the vascular system or get retained in soft tissues adjacent to the vein. Occasionally, the guidewire may be stripped owing to forceful pulling over the puncture needle during the procedure. Retention of such stripped guidewire fragments in soft tissues may remain undetected unless the wire is carefully inspected. While removal of the intravascular guidewire fragments via snare devices is well documented in literature, surgical removal of the fragments lodged in soft tissues may not always be feasible owing to the close proximity to vascular structures or may require extensive exploration for deep-seated fragments, which necessitates using general anesthesia in the pediatric population. Image guided removal may be utilized as a useful alternative for overcoming such issues. We report a case of image guided removal of stripped femoral central line fragments embedded in the soft tissue in a pediatric patient.