title: A Missing Guide Wire After Placement of Peripherally Inserted Central Venous Catheter.
abstract: BACKGROUND Central venous catheterization is a common tool used in critically ill patients to monitor central venous pressure and administer fluids and medications such as vasopressors. Here we present a case of a missing guide wire after placement of peripherally inserted central catheter (PICC), which was incidentally picked up by bedside ultrasound in the intensive care unit.  CASE REPORT A 50-year-old Hispanic male was admitted to the intensive care unit for alcohol intoxication. He was managed for septic shock and required placement of a peripherally inserted central line in his left upper extremity for antibiotics and vasopressor administration. A bedside ultrasound performed by the intensivist to evaluate upper extremity swelling revealed a foreign body in the left arm. Percutaneous procedure by Interventional radiologist was required for retrieval of the guidewire. CONCLUSIONS Guide wire related complications are rarely reported, but are significantly associated with mortality and morbidity. The use of ultrasound guidance placement of PICC lines decreases the risk of complications, provides better optimal vein selection, and enhances success.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Kashif
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
authors.forename: Hafiz
authors.initials: H
authors.lastname: Hashmi
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
authors.forename: Preeti
authors.initials: P
authors.lastname: Jadhav
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
authors.forename: Misbahuddin
authors.initials: M
authors.lastname: Khaja
mesh_terms: D000435:Alcoholic Intoxication / Q000628:therapy; D000800:Angioplasty, Balloon / Q000379:methods; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001132:Arm; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D005547:Foreign Bodies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional / Q000379:methods; D012307:Risk Factors; D012772:Shock, Septic / Q000628:therapy; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents