Rare case of retrieval of a Broken, Dislodged Central Venous Catheter

A retained broken segment is an uncommon but feared complication of central venous catheters (CVCs). Although the embolised fragment may result in catheter dysfunction, arrhythmia, pulmonary symptoms, thrombosis, vascular stenosis, infections, and sepsis, the majority of cases remain asymptomatic. How to recover such fragmented CVC was described in a recently published case study.

A 38-year-old woman was transferred to OT for an awake craniotomy and tumour removal. Under ultrasound guidance and with appropriate local anaesthetic skin infiltration, the right internal jugular vein was catheterized using a 7 French triple lumen CVC. Following confirmation of blood flow in all three lumens, the catheter was attached to the skin using 3-0 non-absorbable monofilament nylon sutures. The patient maintained a sinus rhythm throughout the surgery.

The tip of the CVC was verified to be in the right atrium by examination of the standard chest radiograph done in the immediate postoperative period. The patient complained of discomfort at the suture site of the CVC on the first postoperative day. When the dressing was removed to allow for a more thorough examination of the location, it was discovered that the catheter had separated from the flanges but could not be identified subcutaneously. After consulting with cardiologists, the decision was taken to extract the catheter tip through the right femoral vein. The patient was transported to the Cath lab after obtaining informed consent, and fluoroscopy revealed that the distal section of the catheter from the flanges had been severed and dislodged into the right heart. A 15-mm Amplatz Goose Neck® snare was placed into the right femoral vein and the fragment was retrieved from the right ventricle under image intensifier guidance.