Guidewire Dislodgment of Inferior Vena Cava Filters During Insertion of Central Venous Catheters

The authors report two cases of titanium Greenfield filters dislodged by guidewires during the insertion of central venous catheters. Both were trauma victims who had the venous catheters inserted into femoral veins several days after correct placement of the inferior vena cava filters. A literature review found nine others cases of guidewire dislodg ment of vena cava filters. Eight Vena-Tech filters and one titanium Greenfield filter had been in place for up to 2 months. The guidewires were inserted into femoral, subclavian, internal jugular, or axillary veins. Filters were dislodged cephalad into the atrium, brachiocephalic, and subclavian veins, or caudad into the distal inferior vena cava. Limiting the distance that a guidewire is inserted into a vein during central line insertion is the easiest way to avoid this complication. Inserting the straight end of the guidewire would also be effective.