In last week's NEJM, author Matt Bivens reports an extraordinary experience: while inserting a venous catheter, he let go of the guidewire and moments later looked and saw it migrating into the patient's jugular vein, on its own. He grabbed it as it was running away, just before it escaped from him. While I can imagine, as he did, how it may have happened, it is an exceptional claim. Some aspect of the venous circulation or respiratory motion must have been pulling the wire downstream into the patient, if this story is true. I say "if" because it is truly extraordinary. Not only must the venous circulatory flow have been "grabbing" the wire, carrying it downstream, it had to do so with enough force to overcome the friction of the wire as it traversed the tissues of the neck. (Not mentioned is the size of the patient's neck or whether this happened pre- or post-dilation, or whether the patient was in Trendelenberg - if so the catheter had to be pulled up hill!)I have never seen or felt a guidewire move in such a way, over 20 years and thousands of lines. However, I did turn my back on an intern circa 2000 and that intern pushed and/or flushed the guidewire into the patient. So I was interested in the 4 references in the article purporting to show that guidewires have wings or feet or that the venous circulation can pull them and overcome the tissue resistance and mass of the wire. Here is a summary:
