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Correspondence  |   August 2018
Retained Central Venous Guidewires: Are We Flushing Them Out?
Author Notes
  • Kent and Canterbury Hospital, Canterbury, United Kingdom (R.K.). ritoo.kapoor@nhs.net
  • (Accepted for publication May 14, 2018.)
    (Accepted for publication May 14, 2018.)×
Article Information
Correspondence
Correspondence   |   August 2018
Retained Central Venous Guidewires: Are We Flushing Them Out?
Anesthesiology 8 2018, Vol.129, 371-372. doi:10.1097/ALN.0000000000002309
Anesthesiology 8 2018, Vol.129, 371-372. doi:10.1097/ALN.0000000000002309
To the Editor:
We read with interest the article by Mariyaselvam et al. highlighting a unique human factors approach to retained guidewires with their WireSafe kit. While the reported incidence of retained guidewires appears to be on the rise, it is currently running at approximately 0.03%.1,2  The Seldinger technique is the worldwide standard for insertion, but has the potential to result in guidewire retention. Adherence to checklists and training have been mainstays in the prevention of this complication. While checklists ensure awareness that a guidewire has been retained, they do not prevent the incident from occurring. The new WireSafe kit, with procedure completion parts in a locked box that use the guidewire as its “key,” is a novel idea and forces the operator to remove the guidewire to secure the line. However, it does not actually prevent the guidewire from being retained.
While the literature offers multiple causes for retained guidewires,3  the most common being operator distraction, an inadvertent guidewire retention during a central venous line insertion at one of our hospitals demonstrated that guidewires went from being potentially removable to completely retained as a result of flushing the catheter lumens at the end of the procedure. The guidewire does not completely occlude the lumen it passes through. This allows for aspiration of blood, which confirms placement in a vascular structure albeit with resistance. Indeed, this resistance should be a trigger for the operator to consider that the guidewire may still be within the lumen. However, it is easy to understand how this could be overlooked in a busy environment. A false assurance that the lumen is fully patent means that the lumen is then flushed. The guidewire is then pushed further into the patient’s vasculature and becomes inaccessible.
We would therefore like to suggest an addition to the WireSafe kit. We feel that the WireSafe kit may be enhanced by including preloaded “flush” syringes within the locked kit. This will ensure that the guidewire is always removed before the lumens are flushed. For those that prefer to prime the lumens of their central lines before insertion, perhaps a 3-ml preloaded, color-coded syringe clearly marked as “priming solution” could be included within the pack but outside of the locked kit. We believe a forced brake before flushing the central line lumen may prevent a removable guidewire from becoming a “lost” or retained one.
Competing Interests
The authors declare no competing interests.
Ritoo Kapoor, F.C.A.R.C.S.I., Martin Mayall, F.R.C.A., E.D.I.C., M.B.A. Kent and Canterbury Hospital, Canterbury, United Kingdom (R.K.). ritoo.kapoor@nhs.net
References
Vannucci, A, Jeffcoat, A, Ifune, C, Salinas, C, Duncan, JR, Wall, M Special article: Retained guidewires after intraoperative placement of central venous catheters. Anesth Analg 2013; 117:102–8 [Article] [PubMed]
Mariyaselvam, MZA, Catchpole, KR, Menon, DK, Gupta, AK, Young, PJ Preventing retained central venous catheter guidewires: A randomized controlled simulation study using a human factors approach. Anesthesiology 2017; 127:658–65 [Article] [PubMed]
Pokharel, K, Biswas, BK, Tripathi, M, Subedi, A Missed central venous guide wires: A systematic analysis of published case reports. Crit Care Med 2015; 43:1745–56 [Article] [PubMed]