Correspondence  |   August 2018
In Reply
Author Notes
  • University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom (M.Z.A.M.). m.mariyaselvam@nhs.net
  • (Accepted for publication May 14, 2018.)
    (Accepted for publication May 14, 2018.)×
Article Information
Correspondence
Correspondence   |   August 2018
In Reply
Anesthesiology 8 2018, Vol.129, 372-373. doi:10.1097/ALN.0000000000002310
Anesthesiology 8 2018, Vol.129, 372-373. doi:10.1097/ALN.0000000000002310
We would like to thank Camporesi et al. for their interest in the locked procedure pack (WireSafe) and our article. They are, of course, absolutely correct that the WireSafe is not intended to prevent guidewire breakage or malfunction; however, in our simulation it was shown to be highly efficacious in preventing clinicians simply forgetting to remove the whole guidewire.1  We see these as two separate problems requiring two separate solutions. Guidewire fracture or impingement due to kinking or unraveling needs to be addressed with improvements in manufacturing, materials, and operative technique. However, whole guidewire retention due to forgetfulness requires an understanding of human factors science and the inevitable fallibility of human operators, made worse by suboptimal working conditions. The well-recognized success of the energy, transportation, and other high-reliability industries use system changes and fail-safe forcing functions engineered into equipment design to prevent rare, but serious, errors and these are tested in a simulation setting. The incidence we quoted was from the article by Vannucci et al., referring to whole guidewire retention due to forgetfulness, and was 1:3,291.2  Interestingly, the incidence for “operator distraction” from the article by Omar et al. was almost identical at 1:3,221.3  These concordant figures would equate to approximately four forgotten guidewires everyday in the United States (an estimated 5,000,000 central venous catheters are placed annually2 ). A recent article evaluating 391 cases from the U.S. Veterans Health Administration also supported the incidence of forgotten guide wires in the United States, and in addition, showed that 91% were whole—rather than fractured—guidewires.4  Regarding statistical significance for rare events in routine clinical practice, as discussed in our article, studies can seldom be powered to achieve significance.