POST-INSERTION RELATED COMPLICATIONS

Tip Termination
Central venous catheter tip termination should be within the lower third of the SVC. Hemodialysis catheter tip termination is suggested to be upper right atrium. When selecting the insertion site, consider depth from left side approach as left side approaches require longer catheter lengths for proper tip termination.

Complications with Guidewires

Guidewires are associated with a number of potential complications including:

• Separation of the coil from the core: Access will be lost if this occurs. Remove the dilator and wire together without applying too much force.
• Vessel perforation: Some guidewires, particularly those that are kinked, can perforate blood vessels or the heart.
• Malposition: Vessels migrate to unintended locations.
• Displacement of vena cava filters: Guidewires can displace superior or inferior vena cava filters. Verify whether the filters are in place prior to insertion and always track the amount of wire inside the patient.
• Cardiac tamponade: If the wire is stiff or kinked, it can perforate the heart.
• Cardiac dysrhythmias: These result from too much wire inside the heart.
• Loss of guidewire in the vasculature: This occurs when the wire disappears inside the vasculature and embolizes into the heart leading to serious problems.

The best ways to prevent these potentially serious complications include:

• Do not apply excessive force when inserting a catheter
• Do not cut a guidewire
• Do not withdraw against the needle bevel as this may causes kinking, cutting, or fracturing
• Do not insert the solid proximal end without the coil
• Maintain a firm grip on the spring wire guide at all times to prevent losing the catheter. Loss of wire requires Interventional Radiology retrieval.
• Keep a sufficient length of the spring wire guide exposed (a few centimeters)

Go to Section 9:
Tips When Working With Guidewires