Case history/examination:
An 85-year-old woman was admitted to our hospital for treatment of a liver abscess. To ensure nutritional intake following the patient’s loss of appetite, we decided to use a peripherally inserted central catheter (PICC) to facilitate total parenteral nutrition.
The right basilic vein of the forearm was selected and punctured using an ultrasonic guide, and a guidewire was inserted into the vein. At approximately 10 cm, the guidewire encountered strong resistance, and we were unable to remove the guidewire from the patient’s body. Radiography indicated that a knot had formed at the tip of the guidewire (Figure 1).
As there was risk of crushing or breaking from forced removal of the guidewire, surgical intervention was performed under local anesthesia for safe removal. Intraoperative findings revealed that the guidewire had penetrated the vein wall and formed a knot outside the wall (Figure 2). No complications occurred after surgery. Although central venous access catheters are known to cause various complications, this is, to our knowledge, the first report describing knot formation of the guidewire during PICC insertion. Previous reports have shown that forced insertion or withdrawal of a knotted guidewire may cause tearing of the veins and that surgical intervention is appropriate in such cases.1,2 Although this is a rare complication, it is important for clinicians to know that the guidewire can become knotted and be aware of appropriate treatment methods such as surgical intervention.