Q: After finishing the insertion of Central Venous Catheter (CVC), resistance was felt while injecting and checking back-flow of distal port. What should be your first concern?


Answer: Retained Guidewire

 Retained guidewire is a well know complication of CVC insertion. Even before the guidewire is suspected to be lost, resistance to injection and poor backflow from the distal (usually brown) port is the first sign of the retained wire inside the vessel. 

X-ray should be obtained promptly. 


Further reading:

Schummer W, Schummer C, Gaser E, Bartunek R. Loss of the guide wire: Mishap or blunder? Br J Anaesth. 2002;88:144–6.