Knotting of a pulmonary artery catheter in the superior vena cava: surgical removal and a word of caution

Nonsurgical Removal of Knotted Pulmonary Artery Catheter

“…Primary surgical removal performing a cutdown and venotomy at the initial insertion site has also been described [7][8][9]. For large and complex knots, surgical removal is often the only option and is performed via cutdown or open procedures, occasionally requiring cardiopulmonary bypass [6][7][8][9]11].…”

“…evaluation can also assist with diagnosis and PAC knot location as noted in our cases. Several strategies for both surgical and nonsurgical knotted PAC removal have been described [6][7][8][9]. Insertion of a core-guided wire through the PAC under fluoroscopy is often a first step in attempt to unravel the knotted catheter [6][7][8][9][10].…”

“…The retrieval device is then retracted and a small skin incision is made to remove the knotted catheter, or, for larger knots, a venous cutdown is performed [6][7][8][9]. Primary surgical removal performing a cutdown and venotomy at the initial insertion site has also been described [7][8][9]. For large and complex knots, surgical removal is often the only option and is performed via cutdown or open procedures, occasionally requiring cardiopulmonary bypass [6][7][8][9]11].…”

“…Assistance of interventional radiology may be utilized, but may be difficult to arrange in a timely fashion, especially given the after-hours nature of many liver transplantations. Interventional radiology techniques include the use of a retrieval basket, pigtail catheter, loop snare, or endomyocardial biopsy forceps inserted through an alternate venous access site to secure and remove the knotted catheter which is ligated and pulled through the introducer [6][7][8][9]. The retrieval device is then retracted and a small skin incision is made to remove the knotted catheter, or, for larger knots, a venous cutdown is performed [6][7][8][9].…”

“…Interventional radiology techniques include the use of a retrieval basket, pigtail catheter, loop snare, or endomyocardial biopsy forceps inserted through an alternate venous access site to secure and remove the knotted catheter which is ligated and pulled through the introducer [6][7][8][9]. The retrieval device is then retracted and a small skin incision is made to remove the knotted catheter, or, for larger knots, a venous cutdown is performed [6][7][8][9]. Primary surgical removal performing a cutdown and venotomy at the initial insertion site has also been described [7][8][9].…”