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Case report: Managing a knotted Seldinger wire in the subclavian vein during central venous cannulation

[Étude de cas : Extraction d’une broche guide de Seldinger nouée dans la veine sous-clavière pendant une canulation veineuse centrale]

Kamran Z. Khan, FRCA^*, Donald Graham, FRCA, Agota Ermenyi, MD and Woolagasen R. Pillay, FRCS

^* From the Nuffield Department of Anesthetics, University of Oxford, John Radcliffe Hospital, Oxford; and the
Royal Infirmary, Doncaster, United Kingdom.

Address correspondence to: Dr. Kamran Z. Khan, Nuffield Department of Anesthetics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK Phone: +44 1865 851136; Fax: +44 1865 220027; E-mail: kamran.khan{at}nda.ox.ac.uk

Purpose: To describe the successful removal of a knotted Seldinger wire from a subclavian vein, and review the design and structure of guidewires to formulate recommendations to minimize complications associated with the Seldinger technique.

Clinical features: An 81-yr-old patient suffered from an intravascular knotting of a Seldinger wire during subclavian venous cannulation. We describe a technique for successful removal of knotted guidewire under fluoroscopic guidance using the vessel dilator of a central venous cannulation kit. In this case, the technique was successful without associated immediate or delayed complications. Although central venous cannulation with the Seldinger technique is a commonly performed procedure, it may result in numerous complications, including kinking, and rarely complete knotting of the guidewire.

Conclusions: A thorough understanding of procedural complications and physical characteristics of the guidewire is vital in order to ensure patient safety when using the Seldinger technique for central venous cannulation. We have reviewed the relevant literature for guidewire design and structure, associated complications, and provide recommendations for safe use of guidewires.