Management of a Fragmented Angiocatheter During Central Venous Cannulation: A Case Report and Important Lessons

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Device Complications

Background:

• Central venous catheter (CVC) insertion is a common procedure with a low complication rate (0.1%-1%).
• The modified Seldinger technique, specifically the wire-through-the-catheter method, is frequently employed for CVC placement.
• Vigilance is essential during CVC insertion to prevent potential adverse events.

Observation:

• A rare complication involving the fragmentation of an angiocatheter at its hub was observed during central venous cannulation using the modified Seldinger technique.
• The fragmented catheter piece required emergent vascular surgery intervention for removal from the neck.
• This event highlights a potential risk associated with removing the angiocatheter over an indwelling guidewire.

Findings:

• Angiocatheter fragmentation during CVC insertion is a rare but serious complication.
• Prompt management involves leaving the guidewire in place to stabilize the fragment and immediate consultation with vascular surgery.
• Failure to manage promptly can lead to vascular embolization of the catheter fragment.

Implications:

• Clinicians must be aware of the risk of angiocatheter fragmentation during CVC insertion, particularly with the wire-through-the-catheter technique.
• Thorough inspection of all components of the CVC insertion kit before and after use is recommended to prevent such incidents.
• This case underscores the importance of preparedness for rare complications and the need for timely surgical intervention.