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Skip Navigation LinksHome > July 2013 - Volume 117 - Issue 1 > Retained Guidewires After Intraoperative Placement of Centra...
Anesthesia & Analgesia:
doi: 10.1213/ANE.0b013e3182599179
Patient Safety: Special Article

Retained Guidewires After Intraoperative Placement of Central Venous Catheters

Vannucci, Andrea MD*; Jeffcoat, Alicia MD*; Ifune, Catherine MD*; Salinas, Christian MD; Duncan, James R. MD; Wall, Michael MD*

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Continued Medical Education
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Guidewire retention is a rare complication of central venous catheter placement, and has been related to operator fatigue, inexperience, and inattention, and inadequate supervision of trainees. The true incidence of guidewire loss after intraoperative placement of central venous catheters is unknown. We report 4 cases of guidewire loss after central venous access procedures performed by anesthesia providers in the operating room. Worsening of patients’ clinical condition during catheter placement and complex procedures necessitating more than one guidewire insertion are recurring scenarios in cases involving guidewire loss. Over 6 years at our institution, intraoperative wire loss occurred at a rate of 1:3291 procedures (95% confidence interval of 1/10,000 to 8/10,000).

© 2013 International Anesthesia Research Society

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