A 9-month-old, 10-kg infant with suspected acute meningococcemia (fever, petechiae, and initial hemodynamic collapse) was transferred to our pediatric intensive care unit. A triple-lumen catheter (MultiCath 3, 4.5F, 12.5-cm length, Vygon, Aachen, Germany) was inserted percutaneously, by Seldinger technique, without fluoroscopic monitoring, through the right femoral vein. The guide wire and catheter were introduced without encountering any problem, except for a transitory halt of the guide wire 4 cm from the access. Blood could be drawn from the catheter, but after manipulations, the guide wire and catheter were stuck and could not be removed. A radiograph (Figure) revealed a knot at the tip of the catheter/wire. The knot could not be unraveled by using simple maneuvres under fluoroscopic monitoring. To avoid traumatic traction to the vessel wall, the use of a 5 F introducer was followed by the advancement of the catheter/wire into the inferior vena cava. The tip of the catheter/wire was then snared into a vessel, expanding the diameter of the knot until it could be unraveled. The direct withdrawal of the catheter/wire through the femoral vein was then possible. Central venous catheters are extremely helpful in the treatment of critically ill children. The risk of rare but serious complications such as intravascular knotting and vascular injury can be a source of morbidity in pediatric patients.1.Arad I Haskel Y Vinograd I A knot of the subclavian venous catheter in a premature neonate.Am J Perinatol. 1985; 2: 15-16Crossref PubMed Scopus (4) Google Scholar, 2.Perez-Martinez A Vazquez-Garcia M.S Goni-Orayen C Carrascosa-Romero M.C Ruiz-Cano R Martinez-Gutierrez A True knot in an umbilical venous catheter.J Pediatr. 1999; 134: 113Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Even though mortality rates for patients with knots that are removed surgically are not statistically significantly higher compared with those removed by interventional radiologic techniques,3.Karanikas I.D Polychronidis A Vrachatis A Arvanitis D.P Simopoulos C.E Lazarides M.K Removal of knotted intravascular devices: case report and review of the literature.Eur J Vasc Endovasc Surg. 2002; 23: 189-194Abstract Full Text PDF PubMed Scopus (46) Google Scholar simple maneuvres under fluoroscopic monitoring or special techniques developed for those more difficult to handle4.Chinichian A Liebeskind A Zingesser L.H Schechter M.M Knotting of an 8-French “headhunter” catheter and its successful removal.Radiology. 1972; 104: 282PubMed Google Scholar, 5.Hawkins I.F Tonkin A Deflector method for nonsurgical removal of knotted catheters.Radiology. 1973; 106: 705PubMed Google Scholar, 6.Kumar S.P Yans J Kwatra M Loesch D.M Viturawong V Removal of a knotted flow-directed catheter by a nonsurgical method.Ann Intern Med. 1980; 92: 639-640Crossref PubMed Scopus (24) Google Scholar, 7.Tremblay N Taillefer J Hardy J.F Successful non-surgical extraction of a knotted pulmonary artery catheter trapped in the right ventricle.Can J Anaesth. 1992; 39: 293-295Crossref PubMed Scopus (16) Google Scholar should be considered in pediatric patients. In our patient, the use of an introducer permitted manipulation of the knotted wire/catheter in the caval vein, achieving loop opening and wire/catheter removal without surgical intervention.