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It was reported that due to the patient's critical condition and inadequate vascular access, the decision was made to place an emergent central venous catheter (cvc).The left internal jugular vein was selected, and ultrasound guidance was utilized throughout the procedure.Venous access was obtained without difficulty, and the spring wire guide (swg) was advanced smoothly.Ultrasound confirmed appropriate intravascular placement of the guide wire.A small skin incision was made, the tract was dilated, and the catheter was advanced.During attempted removal of the swg, resistance was encountered.With gentle additional traction, the swg was removed; however, the distal end appeared frayed upon removal.Subsequently, when attempting to aspirate and flush the brown port of the catheter, blood and fluid were observed leaking/spraying from a defect in the catheter tubing.A new central line kit was requested.An attempt was made to pass a guide wire through the damaged brown port to facilitate catheter exchange over a wire; however, the wire could not be advanced.The damaged central venous catheter and guide wire were removed in their entirety, and manual pressure was applied to the insertion site.The operator noted the possibility of underlying anatomic vascular challenges.A second swg was introduced; some resistance was again encountered during removal, but with rotational repositioning, the guide wire was successfully removed intact.Manual pressure was maintained while preparations were made for alternative access.A femoral central venous catheter was subsequently placed successfully.Follow-up imaging identified a retained wire fragment.A ct chest without contrast performed on (b)(6) 2026 referenced prior imaging from (b)(6) 2026, noting a new linear opacity initially presumed external to the patient.Further evaluation determined this to represent a thin metallic wire, potentially a guidewire fragment, extending from the superior vena cava through the right atrium and into the right hepatic vein.This finding was not present on prior imaging following picc placement.The patient was transferred to an outside hospital for ongoing care.Interventional radiology planned to attempt retrieval of the retained fragment, with cardiothoracic surgery consultation if necessary.Follow-up information regarding retrieval outcome was not available despite attempts to obtain additional details from the receiving facility.
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