Accidental Migration of an Intravenous Infusion Catheter from the Arm to the Lung

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The use of intravenous catheters for the administration of fluids has rapidly grown in acceptance. They are not without hazard, however, as illustrated in the following case report, in which a catheter progressed from an injection site in the right antecubital vein to the lung. Case Report A 55-year-old Negro male was seen in the emergency room of Barnes Hospital, St. Louis, Mo., on March 23, 1965, because of intermittent convulsive episodes becoming progressively more severe over a period of three hours prior to admission. In the emergency room the patient had several convulsive seizures and was irritable and combative. Sedation was given intravenously and intramuscularly. An Intracath tubing 2 was threaded into the right antecubital vein, and an infusion of fluids was begun. On the way to the ward a physician noted hemorrhage at the site of insertion of the intravenous tubing. Upon investigation, the distal (intravascular) portion of the polyvinyl tubing was missing. A tourniquet was placed about the right arm, and roentgenograms of the arm and chest were obtained. The remaining portion of the catheter was coiled upon itself in the right atrium and under fluoroscopy was seen bounding to and fro on the tricuspid valve (Fig. 1). Because of the patient's clinical status and since most such intracardiac foreign bodies soon migrate to the lung, immediate surgical intervention was not deemed necessary. A roentgenographic examination of the chest fifteen hours after admission revealed that the catheter had now progressed into the right lung, with the distal portion lying in the anterior segmental artery of the right lower lobe and the proximal portion lying just distal to the right pulmonary artery (Fig. 2). Fluoroscopy demonstrated a marked whipping motion of the proximal end of the fragment. On the eighth hospital day a right thoracotomy was carried out. The catheter fragment measuring 15 cm in length was removed from the anterior segmental artery of the right lower lobe through a 1 cm incision in the diaphragmatic surface of the lung (Fig. 3). Small soft thrombi extended from each end of the fragment. The patient made an uneventful recovery. Discussion The accidental migration of an intravenous infusion catheter from the arm to the heart was first reported in 1954 (1). Loss of a catheter from a commercially produced infusion set was first reported in 1963 (2). In all previous reports the catheter was either recovered from the heart, an extremity vein, or not at all during life but found in the heart or lung at postmortem examination (2–5). These reported cases probably represent only a small proportion of the number of instances in which intravenous infusion catheters have been “lost.” We are aware of at least four patients in whom catheters migrated intravenously without complication and without detection of the site of embolism.