Anaesth Intensive Care 2014; 42: 263-277 Correspondence Yet another missed central venous guidewire! A missed guidewire during central venous catheter- isation is a preventable complication which continues to occur in spite of the extensive information about its hazards 1,2 and prevention 3,4,5 . We experienced yet another situation involving a missed guidewire. This occurred because we did not adhere to standard guidelines. During the central venous catheter placement through the right internal jugular vein, the guidewire was not appropriately anchored during advancement of the catheter. This resulted in the entire length of the guidewire entering the vein. The operator failed to recognise or report the loss of the guidewire, but fortunately it was seen on a routine check X-ray (Figure 1). Initially it was considered an artifact of multiple electrocardiography wires. However, it was confirmed on a subsequent chest X-ray. The guidewire was successfully retrieved by percutaneous angiographic snaring through the femoral vein by an interventional cardiologist in our cardiac catheterisation laboratory. We feel that the problem could have been prevented if the practitioner inserting the central venous catheter had adequate experience with the technique or had been appropriately supervised. The technique for preventing loss of a guidewire is well described and not difficult to achieve given appropriate training. Nevertheless, increasing aware- ness of the complication may also help to reduce its incidence. K. Pokharel M. Tripathi S. V. Rao G. G. Jacob S. Khatiwada Vellore, India References 1. Taslimi R, Safari S, Kazemeini A, Aminian A, Joneidi E, Larti F. Abdominal pain due to a lost guide wire: a case report. Cases J 2009; 2:6680. 2. Perez-Diez D, Salgado-Fernandez J, Vazquez-Gonzalez N, Calvino-Santos R, Vazquez-Rodriguez JM, Aldama-Lopez G et al. Images in cardiovascular medicine. Percutaneous retrieval of a lost guidewire that caused cardiac tamponade. Circulation 2007; 115:629-631. 3. Vannucci A, Jeffcoat A, Ifune C, Salinas C, Duncan JR, Wall M. Retained guide wires after intraoperative placement of central venous catheters. Anesth Analg 2013; 117:102-108. 4. Schummer W, Schummer C, Gaser E, Bartunek R. Loss of the guide wire: mishap or blunder? Br J Anaesth 2002; 88:144-146. 5. Heitmiller E, Martinez E, Pronovost PJ. Identifying and learning from mistakes. Anesthesiology 2007; 106:654-656. Air-raising ST-uff A 45-year-old woman suffered an out-of-hospital cardiac arrest. She reverted to sinus rhythm following 20 minutes of cardiopulmonary resuscitation, in- cluding two defibrillation shocks by bystanders and paramedics. On arrival at a rural hospital emergency department at midnight, she presented as deeply unconscious and severely hypoxaemic from severe acute pulmonary oedema and was endotracheally intubated by a consultant anaesthetist without any difficulty. Two electrocardiograms (ECG) ten minutes apart showed minor lateral lead sinus tachycardia (ST)-segment depression of <0.5 mm. In the intensive care unit, she was hypotensive on dobutamine (~10 µg/kg/minute) and adrenaline infusions (~10 µg/minute) and hypoxaemic (PaO 2 /FiO 2 ratio <80), with clinical and radiological acute pulmonary oed- ema severe enough to cause endotracheal tube blockage. Endotracheal tube replacement resulted in effective ventilation, albeit with high airway pressures. Left internal jugular vein catheterisation Figure 1: Anteroposterior chest X-ray revealing the retained guidewire residing inside the central venous catheter, superior vena cava, right atrium and inferior vena cava. Anaesthesia and Intensive Care, Vol. 42, No. 2, March 2014 View publication stats View publication stats