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A complication associated with central line removal in the pediatric population: retained fixed catheter fragments
Sarah A Jones1, Michael Giacomantonio
1Division of Pediatric Surgery, Dalhousie University, IWK Health Center, Halifax, Nova Scotia, Canada.
Insights
Central venous catheter removal can lead to complications, with some lines breaking and leaving fragments in the venous system. Further research is needed to address the long-term effects of retained catheter fragments.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Oncology
Background:
- Complications associated with central venous catheter insertion and indwelling periods are well-documented.
- Literature regarding complications during central venous catheter removal is limited.
Observation:
- A retrospective review analyzed 136 central line removals (Broviacs, Port-A-Caths, Hickmans) over five years.
- Catheter fragments remained in the central venous system in three cases due to breakage during removal.
- No thrombus formation or migration was observed in residual catheter fragments during follow-up.
Findings:
- Central venous catheter removal presents unique complications, including catheter breakage.
- Three Port-A-Cath lines fractured during removal, leaving segments within the superior vena cava, innominate vein, or bracheo-cephalic subclavian junction.
- The majority of lines (97%) were removed post-chemotherapy, while 3% were removed due to sepsis or malfunction.
Implications:
- Identifies catheter breakage during removal as a specific complication.
- Highlights the need for further investigation into the long-term effects of retained central venous catheter fragments.
- Underscores the necessity of developing strategies for the complete removal of foreign bodies from the central venous system.
Background:
There are many reports on the complications that occur at the time of insertion and during the life of central venous indwelling catheters. However, there is no literature that describes the complications that occur at the time of removal of these lines.
Methods:
A retrospective review of 136 central line (Broviacs [B], Port-A- Caths [PC] and Hickmans [HC]) removals during the last 5 years was undertaken.
Results:
A total of 97% were removed after completion of chemotherapy, and 3% because of sepsis or malfunction. Three PC lines broke at the time of removal resulting in a length of line remaining in the central venous system (the superior vena cava, innominate vein, and bracheo-cephalic subclavian junction). Two lines were inserted by a cut-down technique into the external jugular and one line by the percutaneous technique into the subclavian vein. At follow-up, none of the residual lines were associated with thrombus formation, and none showed any evidence of migration.
Conclusions:
This review identifies a specific problem that can occur with central line removal. Both the long-term affects of residual catheter within the central venous system and the need to remove the foreign body have yet to be addressed.