Retained intravascular fragments after removal of indwelling central venous catheters: a single institution experience

Bautista, Francisco; Gómez-Chacón, J; Costa, É.; Moreno, Lucas; Cañete, Adela; Muro, Maria Dolores; Velázquez, J Dávila; Castel, Victoria

doi:10.1016/j.jpedsurg.2010.02.001

Cited by 15 publications

(13 citation statements)

References 12 publications

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“…12 Bautista et al reported CVC remnants in 1.6% of the cases in their cohort of pediatric patients, with all of the CVC's used for a prolonged period of time in combination with chemotherapy. 5 The CVC remnants are probably caused by breakage of the lines because of fixation of the catheters by scar formation with calcification of the fibrin. 13 A systematic review by Surov et al reported on 215 cases of intravenous catheter embolization.…”

Section: Discussionmentioning

confidence: 99%

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An Unexpected Case of Late Fatal Central Venous Catheter Sepsis: A Case Report

et al. 2020

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Introduction Central venous catheters (CVC) are associated with risks and complications. Complications like vessel perforation, thrombosis, infection with significant morbidity and mortality, knotting, and ventricular perforation have been described. Another less-frequent complication is retained CVC fragments. We present a case of a very late but fatal complication after a CVC placement. This report is written in line with the consensus-based surgical case report guidelines (SCARE). Case A 46-year-old male presented to the emergency department in a critical (septic) shock. The patients' medical history featured a long–intensive care admission 28 years ago. The cause of this sepsis was not evident until a computed tomography scan was performed to exclude a pulmonary embolism, revealing a remnant of a central catheter in both pulmonary arteries. Despite extensive resuscitation, the patient died within 24 hours after admission. An autopsy was performed confirming that the catheter remnant was the only possible cause of the fatal sepsis. Discussion CVC's are associated with (fatal) complications; however, retainment of remnants are described unfrequently but do occur in almost 2% of the cases. Endovascular removal of these remnants has been performed successfully and should be the first treatment of choice if removal is considered. No evidence is available that suggests that routine removal has to be attempted but some longer term complications can be expected, so awareness of possible remnants after CVC removal should exist. Conclusion Retained fragments of CVC's are rare but are described after prolonged use. This case shows that these retained intravascular fragments can cause fatal complications on the long-term. Upon removal of CVC's, there should be awareness that retainment of fragments can occur.

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Section: Discussionmentioning

confidence: 99%

“…Retainment of CVC fragments after removal are rare and have been described after prolonged use. 5 Long-term fatal infectious complications of these CVC remnants have not been described yet. We present a rare case of a very late but fatal complication after a CVC placement according to the consensus based surgical case report guidelines (SCARE).…”

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confidence: 99%

An Unexpected Case of Late Fatal Central Venous Catheter Sepsis: A Case Report

et al. 2020

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“…The frequency of major and minor complications with CVC removal has not been diffusely investigated; the largest reported series of cases has been documented by Maizlin and coworkers in which four life-threatening complications occurred among 1019 CVCs removed. Most available studies of CVC removal are limited to case reports of life-threatening complications that occasionally occurred during or after the procedure (3)(4)(5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

“…Unlike the device insertion and maintenance, governed by detailed evidence-based guidelines (1, 2), long-term CVC removal once the treatment is over is usually performed according to the physician's personal experience without established rules. Although removal is considered as a minor surgical procedure, often performed by young and not fully experienced staff, it has been shown to be associated with non-negligible incidence of complications, such as retention of CVC fragments within the subcutaneous tunnel or in the vessel, with subsequent high risk of foreign body embolism or thrombosis, or air embolism during the procedure (3–8). In addition, the removal could be troublesome if the cuff is far from the exit site, it is placed deep in the subcutaneous tissue, or the device has been inserted in place for a long period (3, 4).…”

Section: Introductionmentioning

confidence: 99%

A Dedicated Protocol and Environment for central venous Catheter removal in Pediatric Patients Affected by Onco-Hematological Diseases

et al. 2014

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Purpose The removal of long-term central venous catheters (CVCs) is not performed according to evidence-based guidelines, thus conveying the message that it is a procedure of secondary importance. Our study aims at comparing the experience at Bambino Gesù Pediatric Hospital before and after the implementation of a dedicated protocol and the identification of a specific area to perform such a procedure under the so-called nonoperating room anesthesia (NORA). Methods Starting on January 1, 2010, an appropriate protocol regarding long-term CVC removal was applied. Then, data from all patients who underwent CVC removal under NORA regimen were compared with patients who have undergone the same procedure before the beginning of such protocol in terms of complication rate, duration of procedure, and costs. Results Between January 2010 and December 2012, 266 patients were evaluated for long-term CVC removal under a NORA regimen. Of these, 194 underwent the procedure. In the period from January 2007 to December 2009, 60 out of 82 patients scheduled for elective removal of long-term CVC in the operating theatre were eligible for this study. Median procedure time was 7 min for removal in NORA and 10 min for the operating theatre (p=0.016); no complications occurred. Conclusion Long-term CVC removal is an often-neglected procedure, carrying a small, but definite rate of complications. Our study shows that CVC removal performed in NORA regimen is safe and feasible, also allowing multiple procedures in the same session with prompt management of possible complications and reduction of the anxiety and pain associated with the procedure.

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“…These findings align with previous studies, which reported an incidence of 0.3 to 2 per cent for retained catheter fragments as well as increasing risk of catheter fragmentation with longer port duration. [2][3][4] Previously, multiple international institutions have described their experiences with retained catheter fragments. In 2009, Milbrandt et al identified six patients (2%) who had retained catheter fragments from a total of 299 central venous lines removed at two tertiary Canadian pediatric hospitals.…”

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confidence: 99%