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Early transection of a central venous catheter in a sedated ICU patient

J C de Graaff1, L J Bras, J A Vos

  • 1Department of Anesthesiology and Intensive Care, St Antonius Hospital PO Box 2500, 3430 EM Nieuwegein, The Netherlands. j.de.graaff@antonius.net

British Journal of Anaesthesia
|September 26, 2006
PubMed

Insights

A subclavian venous catheter fractured and embolized to the heart in a ventilated patient. Percutaneous retrieval via the femoral vein successfully removed the catheter fragment, preventing further complications.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Medical Devices

Background:

  • Subclavian venous catheters are essential for long-term intravenous access in critically ill patients.
  • Catheter-related complications, such as embolization, pose significant risks.
  • Immobilized and mechanically ventilated patients are particularly susceptible to catheter-related issues.

Observation:

  • A case of subclavian venous catheter transection and embolization to the heart is presented.
  • The patient was immobilized and mechanically ventilated, increasing the risk of catheter complications.
  • Symptoms included intermittent difficulties with drug injection and chest wall swelling at the insertion site, indicative of pinch-off syndrome.

Findings:

  • Pinch-off syndrome, caused by mechanical compression of the catheter at the costoclavicular area, was diagnosed.
  • The catheter tip was successfully retrieved using a percutaneous method through the left femoral vein.
  • Chest radiography confirmed the diagnosis, with or without contrast administration.

Implications:

  • Percutaneous retrieval is a viable and effective treatment for catheter embolization.
  • A more lateral approach for subclavian vein cannulation is recommended to prevent pinch-off syndrome.
  • Awareness of pinch-off syndrome and its management is crucial for clinicians managing central venous catheters.

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