Inadvertent guidewire retention after radial artery cannulation: report of two cases and safety lessons for vascular access practice.

BACKGROUND

Inadvertent guidewire retention is an uncommon but potentially serious complication most often described in the context of central venous catheterization, and reports involving arterial access are exceptionally rare. This report describes two cases of inadvertent guidewire retention following radial artery cannulation performed using the Seldinger technique for intraoperative hemodynamic monitoring. CASE PRESENTATION: In both cases, arterial cannulation was indicated because of complex (and possibly prolonged) surgical procedures with a risk of clinically significant blood loss, thereby necessitating continuous beat-to-beat arterial pressure monitoring. The presumed embolization mechanism involved advancement of the catheter while the pre-attached proximal cap remained in place, thereby preventing the guidewire from exiting proximally and ultimately leading to intravascular displacement of the wire. In the first case, the event remained unrecognized until the patient developed forearm pain, reduced radial and ulnar pulses, and sensory changes to the affected upper extremity several weeks postoperatively. Imaging revealed a retained guidewire extending from the radial artery to the axillary artery, requiring surgical intervention for retrieval. In the second case, the inadvertently retained guidewire was found incidentally on a routine chest radiograph eighteen days postoperatively.

CONCLUSIONS

These cases illustrate that guidewire retention, albeit rare, can occur during arterial cannulation by the Seldinger technique and shares the same human-factor vulnerabilities long recognized in central venous access-related guidewire retention, including distraction, incomplete preparation and loss of wire control. In response, several system-level safety measures were implemented, including explicit “wire in hand” confirmation before catheter advancement, the use of wire length markers, mandatory removal of manufacturer attached catheter caps prior to insertion, optional sterile forceps control of the guidewire, multidisciplinary verification, and mandatory documentation of guidewire retrieval. These events reinforce the need for robust safety barriers across all procedures using the Seldinger technique to prevent guidewire retention and enhance procedural safety.