Encontrando lo inesperado: una pieza olvidada de cables CDI dificulta la inserción de la guía del catéter venoso central

Insertion of central venous catheters (central venous catheter or vascath) is very common practice in intensive care units to give vasoactive drugs or renal replacement therapy. But these vascular catheters are also source of infection if they are kept for longer period unnecessarily or proper nursing care is not taken. Replacement of such lines is indicated if they are suspected to be source of infection. Recent practice is to insert new line on alternate sites using Seldinger technique under real-time ultrasound guidance. Sometimes unexpected difficulties are encountered due to anomalies in the veins or the body anatomy. But rarely some left out part of leads from previously inserted cardiac device can present with extreme difficulty in threading the guidewire. We, hereby, report such a case where we faced extreme difficulty in threading the guidewire during central venous access in a patient with previously implanted cardio-verter defibrillator, which was removed after heart transplant.