Silastic catheter separation due to subcutaneous suture

The development of large-bore, double-lumen Silastic catheters for introduction into the superior vena cava has made it possible for patients with renal failure to receive immediate dialysis while awaiting maturation of an arteriovenous fistula. Although infections and thrombotic complications have been well documented, separation of Silastic cannulas has seldom been described and is poorly explained. The authors report two such cases. In one the catheter was clearly sheared off due to snaring by a subcutaneous suture. In the second case, awareness of the possibility of such a complication allowed the authors to explore the catheter at the level of the venotomy. By dividing the suture under direct vision, they were able to remove the snared catheter before it became transected.