Retained and Knotted Guidewires during Central Venous Catheterisation: A Case Series on Anaesthetic Management, Endovascular Retrieval, and Preventive Strategies

Retained or knotted guidewires during Central Venous Catheterisation (CVC) are rare but entirely preventable complications that may result in serious cardiovascular and vascular consequences, including arrhythmias, embolisation and vascular injury. Despite widespread adoption of ultrasound-guided techniques, guidewire-related events continue to occur, particularly in highpressure clinical environments. Present case series is of three patients who developed guidewire-related complications following right subclavian vein cannulation. Two patients experienced complete guidewire retention with distal migration extending from the superior vena cava to the ipsilateral iliac vein, while one patient developed intravascular knotting at the subclavian– brachiocephalic junction following resistance during insertion. All patients were haemodynamically stable at presentation, with one reporting intermittent palpitations. Endovascular retrieval was performed in a hybrid operating theatre using a femoral venous approach with a 7 French sheath and a 5 French vascular snare under fluoroscopic guidance. All procedures were conducted under Monitored Anaesthesia Care (MAC) using midazolam, fentanyl and dexmedetomidine, which provided cooperative sedation, preserved spontaneous ventilation, and haemodynamic stability throughout the intervention. Retrieval was successful in all three cases without vascular injury, arrhythmias, or procedure-related complications. Postprocedure imaging confirmed complete removal of the guidewire without residual fragments. This case series is unique in emphasising the anaesthetic considerations during endovascular retrieval of retained and knotted guidewires, an aspect that is infrequently described in existing literature. It underscores the importance of early recognition, multidisciplinary coordination, and vigilant anaesthetic management, while reinforcing strict adherence to guidewire handling techniques to prevent these potentially catastrophic yet avoidable complications.