Ultrasound-guided retrieval of a retain guidewire in the femoral region of a 4-year-old male with anasarca: a case report

Percutaneous central venous catheters (CVCs) are essential for children with difficult intravenous access but carry a risk of complications. Guidewire-related incidents, such as fracture or retention, are rare but serious. These challenges are exacerbated in patients with severe generalized anasarca, where physiological changes can complicate even standard procedures. A 4-year-old male with nephrotic syndrome and severe anasarca on mechanical ventilation required a central venous access. During an ultrasound guided attempt via the right femoral vein, the J-shaped guidewire met with some resistance, after which it was withdrawn with some force. Due to severe anasarca, bedside ultrasonography (USG) failed to localise the retained segment thus making it impossible to explore. The child was sick and intubated. Upon gradual decrease in anasarca, as the bedside X-ray confirmed a knotted, retained piece in the thigh, two more attempts of bedside USG guided exploration under sedation was tried but failed. Two days later, cellulitis developed at the site. The child was taken to the operating room, where an ultrasound-guided needle was used to mark the exact location of the foreign body. This guided surgical incision and dissection, leading to the successful retrieval of the knotted guidewire. Ultrasound guidance seems to be an effective way to localize retained fragments of guidewires located in the soft tissue of the thigh in children.