Critical Care and Shock

Peripherally-inserted central catheters: Watch for retained wires!

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An increasing number of patients are being admitted to critical care units with multiple chronic medical conditions. In some of these patients, intravenous access is a challenge. With a concern for indwelling catheter infections, peripherally inserted central catheters (PICC). These lines have been advocated due to their lower rate of complications and comfort to the patients. PICC are routinely inserted by physicians and trained nurses. Complications such as pneumothorax and infections are lower than in central venous lines and the incidence of retained guide wire is minimal and in some cases unrecognized.
We recently had one such case. An elderly man with sepsis required a PICC placement. A trained nurse attempted to place it when she recognized that the guidewire was missing, as the vessel dilator was being used. A chest radiograph confirmed that the guidewire remained in the patient’s chest cavity. Interventional radiology successfully retrieved the missing wire. Vigilance and frequent refresher courses are required to evaluate the competency among health care workers placing these catheters to help avoid complications.

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