Successful removal of j-guide wire guidance lost during jugular vein catheterization in an Arabian mare

Introduction

Guidewire venous catheterization complications have been sparsely reported in equine medicine.

Clinical History / Treatment and Management

A 10 year-old Arabian mare was being hospitalized and needed her venous access replaced. The mare was prepared for placement of a 15 cm x 16 gauge MILA® over-the-wire Seldinger intravenous catheter. An 18-gauge catheter was inserted in the proximal left jugular vein and a 45 cm flexible braided stainless guide wire was passed through it. The operator failed to retain the guidewire, which then slipped into the left jugular vein. Transcutaneous ultrasonography and radiographs revealed that the guidewire was positioned at the caudal cervical third of the left jugular vein. The removal was performed transcutaneously, under standing sedation with detomidine and butorphanol. The left jugular vein was surgically prepared, the procedure was guided by ultrasonography, the blood flow was reduced by a cranial transcutaneous compression of the vein with a Kelly forceps. A 2 cm long longitudinal skin incision was performed over the vein at the level of the cranial tip of the wire, the muscles were retracted by a Weitlaner retractor, and the jugular vein was isolated, the tip of the guidewire was gently held by forceps through the vessel and a 2 mm long venotomy was then made and the wire extracted. The adventitia of the vein and subcutaneous tissues were sutured with Vicryl® 2.0 and the skin with Ethilon® 1. The time from wire loss to wire removal was approximately 45 minutes.

Evolution

During the following days, the mare was closely monitored and a few days later was discharged from the hospital without complications. No swelling or hematoma formation was observed.

Discussion

The surgical removal trough small venotomy was a time-efficient option that prevented cardiac arrhythmias, vascular damage, thrombosis and led to a successful outcome.

References

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