Monday, November 23, 2009

Monday November 23, 2009
Bedside trick!

Scenario: You are inserting an emergent femoral central line in a severely vasculopath patient with exhausted upper vessels. Patient has previous history of IVC filter placement. What would be your worry?



Answer: Dislodgment of Inferior Vena Caval Filter.

Many cases have been reported in literature where IVC filters get dislodged by guidewires during the insertion of central venous catheters. 3 precautions/tricks can prevent this complication

  • Limiting the distance that a guidewire is inserted into a vein during central line insertion.
  • Inserting the straight end of the guidewire would also be effective.
  • Inserting a smaller length central venous catheter (16 cm) instead of full 20 cm length central venous catheter.


Guidewire Dislodgment of Inferior Vena Cava Filters During Insertion of Central Venous Catheters - Vascular and Endovascular Surgery, Vol. 31, No. 5, 587-593 (1997)