Unique use of a tip-deflecting guide wire in removing a catheter embolus from an infant

Abstract

An umbilical catheter fragment embolus in a neonate was difficult to approach due to fixation of both ends, in the left atrial appendage and the ductus venosus, respectively. A tip-deflecting guide wire was used in unique fashion to free the catheter fragment and allow its percutaneous removal via the femoral vein approach.

Retrieval of a retained umbilical vein catheter at 6 months

“…Rarely, this complication can also occur after insertion of the catheter, where tight sutures can also cause fractures 3. The 18 cases currently in the literature are outlined in table 1 3–18. In our case, the incident was unreported during the neonatal period.…”

“…In the remaining nine cases, the endovascular approach was successfully used where the catheter had migrated centrally (table 1). 3–8 11 13 14 Fifteen of the cases reported were delivered prematurely and 10 had very low birth weight (table 1). In 10 out of 18 cases, the catheter had migrated inside the cardiac chamber or major vessels, while in 8 out of 18 cases, it was retained in the umbilical vein.…”

Percutaneous retrieval of umbilical vein catheter fragment in an infant two months after embolization

“…However, a broken fragment of UVC may seldomly embolize to intravascular or cardiac structures and some newborn cases undergoing transcatheter retrieval of embolized fragments have been reported in the literature. [1][2][3][4][5][6] Broken fragments in previous cases had embolized to pulmonary artery, left atrium, and pulmonary vein. [1][2][3]6 As to our patient, the proximal end of the catheter was in hepatic vein and the distal end was extending into right atrium.…”

“…Despite it may vary according to the site of embolization, femoral vein and umbilical vein were generally preferred routes of access for transcatheter removal. 1,3,4 Amplatz goose-neck snare, loop snare, and helical basket catheter were the most frequently used devices in this manner. 1,3,6 The probability of retrieval success is expected to decrease with increasing duration of catheter embolization owing to increased risk of thrombi.…”

Umbilical venous catheter retrieval in a 970 gm neonate by a novel technique

“…Though there are few case reports available in the literature of surgical[3] and percutaneous retrieval[456789] of retained UVC from an infant, yet to the best of our knowledge, there are only anecdotes in the literature of percutaneous retrieval of umbilical venous catheter in less than one kg neonate. [1]…”