Central Venous Catheter Fragment Research Articles

\u201cPigtail through snare\u201d technique: an easy and fast way to retrieve a catheter fragment with inaccessible ends

BackgroundA catheter fragment with inaccessible ends can be retrieved using the well-known two-step method: making a free end with a pigtail catheter and seizing it with a snare catheter. Here we propose an easier and faster modification, named the “pigtail through snare” technique.Case presentationA 61-year-old female patient underwent removal of a central venous catheter fragment migrating to the right atrium. Both ends located in the right atrial appendage and left hepatic vein were inaccessible. Initially, a snare loop was opened in the inferior vena cava and a pigtail catheter was advanced through the snare loop to hook the catheter fragment. The free end was created by pulling the pigtail catheter, dragged automatically into the snare loop, grasped, and retrieved immediately.ConclusionsBy passing the pigtail catheter through the snare loop in advance, the snaring maneuver becomes easy and fast in retrieving the catheter fragment with inaccessible ends.

Complicated vascular access port removals: incidence, antecedents and avoidance.

Port removal is usually a straightforward procedure delegated to trainees. However, some port removals are complicated by central venous catheter (CVC) fragmentation, a challenge for even experienced surgeons. This study aimed to determine the incidence of, and risk factors for, complicated port removal in children. A single-centre study assessed the outcome of removal for all paediatric ports inserted from 1996 to 2012. Data were recorded detailing patient, insertion, device and removal characteristics. Risk factors for complicated removals were scrutinised using Chi-square tests; p < 0.05 significant. Of 628 ports inserted from 1996 to 2012, 443 were subsequently removed at the same centre. 8/443 (1.8%) removals were complicated by CVC fragmentation, a median of 3.3 (2.4-3.9) years after insertion. Of complicated cases, 8/8 underwent formal neck dissection, 3/8 intravascular dissection, and 1/8 endovascular retrieval. 2/8 cases have retained intravascular CVC fragments. Risk factors for complication were CVC caliber <6Fr (p < 0.001) and use duration >2 years (p < 0.001). Greatest care and senior supervision should be ensured when removing ports with CVC caliber <6Fr and/or >2 years since insertion. However, complications also occur with larger CVCs or after shorter durations. Therefore, the key to avoiding complicated port removal may simply be: preparation, preparation, neck preparation.

Percutaneous Removal of a Fractured Central Venous Catheter Fragment in the Right Ventricle

Percutaneous Removal of a Fractured Central Venous Catheter Fragment in the Right Ventricle

Radiologic Interventional Retrieval of Retained Central Venous Catheter Fragment in Prematurity: Case Report

The fracture of a central venous catheter is a rare but potentially serious complication. Moreover, removal of the broken catheter pieces is considerably challenging, especially for premature infants. We report 3 case studies of the percutaneous transcatheter retrieval of broken catheter parts in 3 premature infants. We confirmed the location of the catheter fragments via a DSA venogram with diluted contrast media. Using the minimum amount of contrast, and extreme caution, we made certain no contrast-induced nephrotoxicity or air embolism occured during catheter manipulation. In addition, when the broken fragment was curled or attached to the cardiac wall, we used a hook-shaped catheter to facilitate the capturing of the catheter with a loopsnare. This report demonstrates the feasibility of removing a retained catheter fragment in a premature infant using a percutaneous transcatheter approach.

Transcatheter Retrieval of Different Types of Central Venous Catheter Fragment: Experience in 13 Cases

In total, 13 patients, from April 1992 to November 2002 at this institution, had embolization caused by central venous catheter fragments including 4 peripherally-inserted central catheters (PICCs), 1 Hickman catheter, 1 Swan-Ganz catheter, and 7 port-A catheters. These dislodged fragments were percutaneously retrieved successfully in 12 patients. As each type of the central venous catheter has its distinct properties, the locations of embolization, detection, and retrieval methods differed.

Acrylic cement pulmonary embolus masquerading as an embolized central venous catheter fragment

An acrylic cement pulmonary embolus is a rare complication of percutaneous vertebroplasty. Many patients remain completely asymptomatic, but others may present with chest discomfort, dyspnea, and even cardiovascular collapse leading to death. Here we present an asymptomatic patient initially thought to have a central venous catheter pulmonary artery embolus based on the morphology of the foreign body on imaging exams. A more thorough investigation established the diagnosis of an acrylic cement pulmonary embolus resulting from percutaneous vertebroplasty procedures performed many months before the embolus discovery. The diagnostic work-up, treatment strategy, and a review of the literature are presented.

Endovascular foreign objects retrieved by interventional radiologists at Universitas Hospital

During the past 4 years, 15 patients have undergone intravascular removal of foreign bodies — 9 central venous line fragments, 3 guidewires, 2 pacemaker leads and 1 misplaced embolisation coil. Ten foreign bodies (including 2 guidewires, 2 pacemaker leads and 6 central venous catheter fragments) were recovered from the big veins and right heart, 3 (central venous line fragments) from the pulmonary arterial system and 2 (an embolisation coil and a guidewire) from the arterial system. The percutaneous removal of foreign bodies is efficient with few complications. Surgery should only be considered for patients in whom removal attempts with endovascular interventional techniques have failed.

Rupture intravasculaire de cathéter épicutanéocave chez le prématuré : place du cathétérisme interventionnel

Central venous access is a frequent procedure in pediatric intensive care and neonatology. Catheter fracture with migration of the distal portion into the vessels is rare but may have side effects such as thrombosis. We report the case of a premature infant who had at three weeks of age a retained central venous catheter fragment in the pulmonary artery. The fragment was successfully retrieved by a percutaneous endovascular technique. No complication was observed during the procedure and afterward. This technique has avoided either delicate surgery or thrombotic risk due to a persistent intravascular foreign body. The authors prompted this interventional procedure within 36 hours after catheter migration in a center experienced in neonatal interventional catheterization.

Surgical retrieval of an embolized central venous catheter in a premature baby

Embolization of central venous catheter fragments is usually treated with percutaneous interventional techniques, which are difficult to apply in infants with very low birth weight. We surgically removed a catheter fragment in a preterm neonate, to avoid the impending thrombosis of the right pulmonary artery. The operation was performed with a nerve hook introduced through a tiny incision in the vessel’s wall. The procedure was well tolerated, and no stricture remains at the site of incision.

Etiology and retrieval of retained central venous catheter fragments within the heart and great vessels of infants and children

Background: The use of centrally positioned venous catheters plays an indispensable role in the care of infants and children. Methods: Since 1992 the authors have seen nine patients who experienced fragmentation and migration of catheter fragments into the central circulation. The patients ranged in age from 6 days to 15 years. Results: Sites of migration included pulmonary artery (five patients), superior vena cava (two patients), hepatic vein and innominate vein (one patient). The elapsed time from recognition of retained catheter fragments until retrieval ranged from a few hours to 6 weeks. Conclusion: All retained fragments were successfully removed during cardiac catheterization without complications.