Spring guidewire sticks in the indwelling catheter during internal jugular vein catheterisation

The right internal jugular vein is most often used for central venous pressure monitoring as it has a straight course. The Seldinger technique is commonly used as it has a reduced incidence of complications. We present an incident in which the spring guidewire stuck in the catheter. A 42-year-old, ASA II, female patient was undergoing surgery for a frontal glioma. Insertion of a CVP catheter in the right internal jugular vein was attempted using a Seldinger technique. After the initial venous puncture was made with the insertion needle and blood withdrawn, a guidewire supplied with the kit was inserted nearly 15 cm through the needle and the needle then withdrawn. The single-lumen Secalon Seldy (Ohmeda) 16G, 20-cm indwelling catheter was threaded on the guidewire to a depth of 12 cm from the skin and then the guidewire was withdrawn. However, after withdrawing the guidewire a few centimetres it stuck in the lumen and could not be pulled out. The whole assembly of the catheter and guidewire was taken out, and on pulling the guidewire the catheter bent at a distance of 10 cm from the hub. It was so firmly stuck that even enormous force could not pull out the guidewire. On cutting open the catheter longitudinally, we found that the part of guidewire that had stuck had an opaque film all around it approximately 3 cm in length. This film was subjected to high-power microscopic examination, which revealed that it was of a homogenous amorphous character with transverse equidistant markings. No cellular element or ghost cells were seen. When this was compared to a shaving of catheter material under magnification, it looked similar apart from the equidistant transverse markings. Thus it was confirmed that this opaque cylindrical wrapping around the catheter was part of the catheter lining. The transverse markings were the impressions of the spring part of the guidewire. This was an unusual complication, which was due either to faulty material or faulty manufacturing of the polyurethane catheter. There is a case report in the literature in which difficulty was encountered in pulling out the guidewire from an indwelling catheter during percutaneous catheterisation of a subclavian vein [1]. The authors in that report suggested that angulation of the guidewire can occur between the clavicle and the first rib, which caused the difficult removal. This was in contrast to our case where we catheterised the internal jugular and introduced the wire through a rigid needle, not through a flexible plastic cannula.