"Anomalies in Chemoport Insertion: Unraveling the Complexity of Guidewire Knotting in a patient with Hodgkin’s Lymphoma - A Case Analysis."

Document Type : Case report

Authors

1 Department of Anaesthesiology, SGPGIMS Lucknow, Uttar Pradesh, INDIA.

2 Department of Endocrine surgery. SGPGIMS Lucknow, Uttar Pradesh, INDIA.

Abstract

Background:
Hodgkin's Lymphoma, a neoplasm often managed through chemotherapy, necessitates the installation of a chemoport for effective treatment delivery. Real-time ultrasound (USG) guidance stands as the preeminent and precise technique for chemoport insertion, demanding adept hands to mitigate potential complications.

Case Presentation:
A 26-year-old female with Hodgkin’s Lymphoma underwent planned chemoport insertion via the Right Internal Jugular Vein (Rt. IJV) under USG guidance. Despite aseptic measures, an unforeseen complication arose during out-of-plane needle insertion, resulting in the entanglement of the guidewire between the Rt. IJV and right subclavian artery. Subsequent failed attempts at guidewire removal prompted Contrast Enhanced Computed Tomography (CECT), revealing entanglement. Surgical exploration under general anesthesia unveiled knotting between the RIJV and Rt. carotid artery. Safe removal necessitated cutting the guidewire, preventing potential major vascular injury. Fluoroscopy post-procedure exhibited no residues. Patient consent for potential publication has been obtained.

Conclusion:
The case underscores Real time ultrasound guidance's importance, cautious force application to avoid any malposition of guidewire, and readiness for surgical intervention under general anesthesia to prevent vascular complications emphasizing the need for interdisciplinary collaboration. Patient consent has been secured for potential publication.

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