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Published on: March 31, 2023
Difficult removal: a Swan-Ganz catheter coiled on the central venous catheter
Jian Shen1, Luyao Ma2, He Huang3
1Department of Anesthesiology, First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing, Jiangsu Province, 210029, PR China.
Insights
Difficult removal of Swan-Ganz catheters, a serious complication in hemodynamic monitoring, can occur when the catheter coils around a central venous catheter. X-ray guidance is recommended for safe removal.
Area of Science:
- Cardiology
- Critical Care Medicine
- Medical Devices
Background:
- The Swan-Ganz catheter is crucial for hemodynamic monitoring in critically ill patients, aiding the understanding of cardiac pathophysiology.
- Difficult removal of the Swan-Ganz catheter is a rare but significant complication.
- Central venous catheters are frequently used in conjunction with Swan-Ganz catheters.
Observation:
- A case of difficult Swan-Ganz catheter removal is presented in a 28-year-old female post-cardiac surgery.
- Imaging revealed the Swan-Ganz catheter had coiled around the central venous catheter within the superior vena cava.
- The coiled catheter presented a unique challenge for removal.
Findings:
- A novel cause for difficult Swan-Ganz catheter removal was identified: coiling around a central venous catheter.
- Successful removal was achieved by first extracting the central venous catheter under X-ray guidance.
- Subsequently, the Swan-Ganz catheter was safely withdrawn using a percutaneous introducer sheath.
Implications:
- This case highlights an unreported etiology for Swan-Ganz catheter removal difficulties.
- X-ray imaging prior to removal may be essential in cases of suspected entanglement.
- The described technique offers a potential solution for similar complex removal scenarios.
Background:
The Swan-Ganz catheter plays an important role in gaining understanding of cardiac pathophysiology and in the hemodynamic monitoring of critically ill patients. Difficult removal of the Swan-Ganz catheter is a rare but serious complication.
Case Presentation:
This case presents the difficult removal of a Swan-Ganz catheter in a 28-year-old female patient after cardiac surgery. Fluoroscopy and chest X-ray revealed that a portion of the Swan-Ganz catheter was coiled on the central venous catheter at the level of the superior vena cava. Under X-ray guidance, the central venous catheter was first removed, and then the Swan-Ganz catheter was successfully withdrawn through the percutaneous introducer sheath.
Conclusions:
This case report provides an unreported reason for difficult removal and describes a successful solution. This report suggests that X-ray examinations may be necessary before removing the Swan-Ganz catheter.
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