Accidental migration of ASH-split catheter during central venous catheter replacement: retrieval using an interventional radiology approach

Retrieval of fractured dialysis catheter through phlebotomy of internal jugular vein: a case report

A central venous catheter is the most common access for initiating hemodialysis. Prolonged access through a central venous catheter increases the risk of infection and dysfunction of the catheter with potential development of catheter-induced thrombosis and embolism. However, fracture and dislodgement of the catheter with subsequent embolization is an unexpected complication. Endovascular treatment is a promising method to remove intravascular foreign bodies. We herein report a case of a 58-year-old woman undergoing prolonged hemodialysis who required central venous catheter removal because of mechanical fracture of the tunneled cuffed catheter and its migration in the internal jugular vein. An urgent chest X-ray showed that the two free ends of the fractured tunneled cuffed catheter were located in the right atrium and right internal jugular vein. Phlebotomy of the internal jugular vein was successfully performed to retrieve the fractured tunneled cuffed catheter and the associated thrombi. In this case, phlebotomy for retrieval of the embolized catheter fragment extending into the right atrium was a safe alternative to an endovascular technique of catheter fragment retrieval. Phlebotomy preserved the integrity of the catheter fragment and its associated thrombus and was both cost-effective and safe.

Central Venous Catheter and the Hemodialysis Patient: A Difficult Symbiosis

In the last ten years, tunneled central venous catheters (pCVCs) have been increasingly utilized in chronic hemodialysis patients, sometimes in the place of fistulas. They have gained popularity for their unquestioned advantages, such as the possibility for immediate use. However, several problems have emerged following their diffusion. In this paper we review the main complications of pCVCs. Complications connected with insertion are generally due to an inaccurate approach to the vein. Ultrasonographic guidance has partially solved this problem and EC-ECG (endocavitary ECG) allows an accurate positioning of the tip. Infections, venous and/or pCVCs) thrombosis and dysfunctions are the most important catheter-related complications. Infections may occur with and without symptoms of systemic illness. Early diagnosis and appropriate antibiotic treatment are essential for saving the catheter. The pathogenesis of infections and strategies for prevention are discussed. Thrombosis and stenosis are well known complications of subclavian and jugular catheterization. In uremic patients, for temporary use, we suggest using the femoral position. Protocols for application of thrombolytic agents in pCVCs are considered. Dysfunction, defined as the failure to maintain a blood flow of at least 250 ml/min, remains the Achilles’ heel of the system. Adequate look therapy and tip position are only two basic aspects. In conclusion, a pessimistic outlook on the matter could lead us to consider that the advantages of catheter use are far outweighed by the disadvantages. However, we cannot avoid using central venous catheters in our dialysis units and a great challenge awaits both physicians and manufactures in the coming years.