SAQ 265 – Administration – retained central-line guidewire and supervision

Question 9. retained central-line guidewire and supervision.

a. Open disclosure

• Apology or expression of regret.
• Factual explanation of what occurred.
• Opportunity for the patient and family to describe their experience.
• Discussion of potential consequences.
• Explanation of management and steps to prevent recurrence.

b. Key management

• Close monitoring.
• Obtain alternative access using ultrasound.
• Arrange guidewire removal by vascular surgery, cardiothoracic surgery, or interventional radiology.
• Admit to a monitored area.
• Support the trainee and consider medical-defence notification.
• Provide immediate and later clinical debriefing.
• Complete incident reporting and thorough documentation.
• Notify hospital legal or risk management.

c. Determining competence

• Complete a competency package and demonstrate knowledge of all aspects of the procedure.
• Observe the procedure with instruction on multiple occasions.
• Perform the procedure under supervision until competence is demonstrated.

d. Initial limitations

• Competency requirements completed.
• Indirect supervision with consultant discussion.
• Selected patients with appropriate indications.
• Avoid predicted difficult procedures.
• Ensure assistance is immediately available.