Q: After inserting central venous catheter, you have hard time (resistance) to flush the distal lumen; Also you have poor venous backflow from the distal lumen; What should be your first thought?


Answer: Lost guide wire

The first thing before you cannot find guide wire or find it on CXR, would be a resistance to injection via the distal lumen and  poor venous backflow from the distal lumen.

Lost guidewire during CVC insertion is a very under-appreciated complication and happens more frequently than thought.

Loss of the guide wire: mishap or blunder? - Br. J. Anaesth. (2002) 88 (1): 144-146.