Central venous catheterization (CVC) is a common procedure that may lead to mechanical, infectious, or thrombotic complications. Among mechanical ones, guidewire knotting and entrapment are exceptionally rare but potentially serious.

We report the case of a 79-year-old woman with community-acquired pneumonia and septic shock. During right subclavian CVC placement, resistance was encountered, and the guidewire became knotted and trapped. Chest X-ray and CT confirmed its intravascular position. The patient was referred to Interventional Cardiology, where percutaneous extraction was successfully achieved through femoral venous access using an EN Snare device, without complications.

This case underscores the need to recognize rare CVC complications and highlights the safety and efficacy of percutaneous retrieval techniques. Risk factors include operator inexperience, prior catheterizations at the same site, multiple punctures, and subclavian access. The use of ultrasound is emphasized to minimize cannulation failures and complications such as arterial puncture, hematoma, pneumothorax, and hemothorax.

Conclusion: Careful technique, early recognition, and a multidisciplinary approach are essential for the safe management of CVC-related guidewire entrapment.

Jose Dario Valencia Gonzalez is a cardiologist at IMSS General Hospital No. 36 in Pachuca, Hidalgo, Mexico. He completed his Cardiology fellowship at UMAE Manuel Ávila Camacho, BUAP, and additional training in Practical Echocardiography and diplomas in Advanced Heart Failure, Clinical Research, and Heart Failure. He has published case reports on cardiac leiomyosarcoma, uncorrected ventricular septal defect, catheter-related complications, and thrombosis. His clinical work focuses on coronary artery disease, heart failure, valvular disorders, and complex cardiovascular complications.