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Bakr L, Ali J. Removal of stuck tunnelled dialysis line requiring cardiopulmonary bypass and venous repair. J Vasc Access 2023:11297298231197290. [PMID: 38142275 DOI: 10.1177/11297298231197290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
Tunnelled central venous dialysis catheters can usually be removed easily. However, their removal can become rarely complicated requiring more invasive techniques. We report a case in which cardiopulmonary bypass and repair of great veins was required for safe removal. A 38-year-old female with end-stage renal failure and a 3-year-old Hickman line inserted into her right internal jugular vein was referred to our cardiac surgical unit following failed attempts of line removal by local vascular surgical team using open vascular surgical techniques. As a result, an MDT decision was made that it was safer to proceed to a cardiothoracic surgical approach rather than other techniques. Investigations showed significant calcification surrounding the line which was adherent to the venous wall. Removal of the retained catheter required median sternotomy and the use of cardiopulmonary bypass as the great veins had to be opened to free the line and allow complete removal. The line was successfully removed with its encircling calcified sheath, and the veins were closed primarily without needing a patch repair. The integrity of the great veins was maintained to meet the on-going need this young patient has for central venous access. The patient made an uneventful recovery. When other measures fail, sternotomy and cardiopulmonary bypass provide a safe option for complete removal of stuck central venous catheters with low risk to the patient.
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Affiliation(s)
- Lubna Bakr
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Jason Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Chatani S, Tsukii R, Nagasawa K, Hasegawa T, Murata S, Kato M, Yamaura H, Onaya H, Matsuo K, Watanabe Y, Inaba Y. Difficult removal of totally implantable venous access devices in adult patients: Incidence, risk factors, and management. J Vasc Access 2023; 24:1150-1157. [PMID: 35081814 DOI: 10.1177/11297298211069256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Totally implantable venous access devices (TIVADs) have played an important role of medical oncology practice. However, operators sometimes encounter considerable difficulty when removing TIVADs. This study aimed to investigate the incidence of difficult TIVAD removal, determine associated risk factors, and investigate interventional radiology (IR) approaches to difficult removal. METHODS A total of 514 TIVAD removal procedures performed in a single-center between January 2014 and May 2021 were retrospectively analyzed to determine incidence of difficult removal and associated risk factors. IR approaches applied in difficult removal cases were also reviewed. RESULTS The incidence of difficult removal was 7.4% (38/514). In univariable analysis, indwelling duration, silicone catheter, and subcutaneous leakage of fluid were identified as significant risk factors for difficult removal. Multivariable analysis showed that indwelling duration per year (odds ratio (OR), 1.46; 95% confidence interval (CI), 1.28-1.67; p < 0.01) and subcutaneous leakage of fluid (OR, 6.04; 95% CI, 2.45-14.91; p < 0.01) were significantly associated with difficult removal. In the 38 difficult removal cases, 32 TIVADs could be removed using more dissection and traction than the standard removal method. In the other 6, TIVADs were successfully removed by using several IR techniques, including insertion of a guide wire (n = 1), dissection using an introducer sheath (n = 2), pushing with a dilator (n = 1), and pulling with a snare (n = 2). CONCLUSION Difficult TIVAD removal is uncommon. However, operators should expect it when removing long indwelling TIVADs and those with subcutaneous leakage. IR approaches to difficult removal are minimally invasive and can be useful.
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Affiliation(s)
- Shohei Chatani
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Ryota Tsukii
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kyohei Nagasawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takaaki Hasegawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shinichi Murata
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Mina Kato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hidekazu Yamaura
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Onaya
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
- Division Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
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Setia A, Khan S, Knez P, Rouhollahpour A, Adili F. [Endoluminal balloon dilatation of impacted central venous catheter-Case report and literature review]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01861-6. [PMID: 37115224 DOI: 10.1007/s00104-023-01861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The long-term application of tunneled central venous catheters leads to the development of firm adhesions between the wall of the vein and the catheter, which makes removal of the catheter difficult or impossible. The treatment options in such cases include abandonment of catheter parts or an open surgical approach up to sternotomy. At present, procedural alternatives are available, which include endovascular techniques such as the use of laser energy and endoluminal dilatation. METHODS This article describes the successful application of endoluminal dilatation for removal of ingrown central venous catheters in three patients, which had impacted in the superior vena cava and brachiocephalic vein. A 5 Fr (Cordis, Santa Clara, CA, USA) sheath was inserted into one lumen through the severed end of the double lumen catheter. Subsequently, a balloon catheter was inserted into the other lumen to prevent retrograde bleeding or air embolism. Under fluoroscopy a guidewire (0.018, Terumo Medical Corporation, Somerset, New Jersey, USA) was introduced via the sheath to beyond the tip of the hemodialysis catheter into the right atrium. Finally, an angioplasty balloon was inserted (4 × 80 mm) via the guidewire and the complete catheter was sequentially inflated with a pressure of 4 atm. It was then possible to pull out the catheter with no difficulty. RESULTS This technique resulted in the removal of the central venous catheters in all three patients, without any relevant complications or resistance. CONCLUSION By dissolving adhesions between the catheter and the vein wall, endoluminal balloon dilatation constitutes a reliable and safe technique for the extraction of impacted central venous hemodialysis catheters and may thus help to avoid further invasive surgical procedures.
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Affiliation(s)
- A Setia
- Klinik für Gefäßmedizin - Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Deutschland
| | - S Khan
- Klinik für Gefäßmedizin - Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Deutschland
| | - P Knez
- Klinik für Gefäßchirurgie, Klinikum Wetzlar, Wetzlar, Deutschland
| | - A Rouhollahpour
- Privatpraxis für Gefäßmedizin und Phlebologie, Hanau, Deutschland
| | - F Adili
- Klinik für Gefäßmedizin - Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Deutschland.
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Gameiro J, Outerelo C, Fortes A. Endovascular treatment of the stuck hemodialysis catheter: A report of two cases and literature review. J Vasc Access 2022; 24:11297298221074449. [PMID: 35090352 DOI: 10.1177/11297298221074449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A considerable number of patients present with stuck CVC after long-use of CVC, which is thought to result from the adhesion of the fibrous sheath, formed over the CVC, to the vessel or atrial wall. The removal of these catheters is a difficult and risky procedure. Hong reported a minimally invasive technique through endoluminal balloon dilation, which successfully breaks the adhesions and expands the vein, thus allowing for an easy removal of the CVC. The authors present two cases of a variant method of Hong's technique, and provide a literature review on stuck catheters. Our experience is that balloon angioplasty dilation is a safe and practical option. We highlight the role of experienced interventional nephrologists or radiologists in the management of this complication as endovascular treatment is the first line treatment.
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Affiliation(s)
- Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Cristina Outerelo
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Alice Fortes
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
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Jung H, Cho JY, Seok Y, Lee Y. Stuck fragment of totally implantable central venous access ports during removal: risk factor analysis in children. BMC Surg 2021; 21:276. [PMID: 34078337 PMCID: PMC8173976 DOI: 10.1186/s12893-021-01271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Totally implantable central venous access ports (TICVAPs) have increasingly been used in pediatric patients because they provide reliable venous access. However, many complications associated with TICVAPs have been reported. Here, we aimed to analyze the risk factors of stuck fragment of TICVAPs during removal in children and recommend the appropriate periods of use or exchange. Methods We retrospectively reviewed the medical records of 121 patients, including 147 cases of TICVAP insertion, between January 2010 and July 2020. Results Among these, 98 cases in 72 patients involved of TICVAP removal, with 8 patients having had incomplete TICVAP removal resulting in a stuck fragment of the catheter in the central venous system (Group S). All Group S patients were male and had acute leukemia, and their TICVAPs were used for chemotherapy. Compared with the complete removal group (Group N), stuck fragment in Group S were significantly found in patients diagnosed with acute leukemia than those with other diagnoses (p < 0.001). Indwelling duration and body weight change during TICVAP indwelling were significantly longer and larger in Group S, respectively (p < 0.001). In multivariate logistic regression analysis, indwell duration (odds ratio [OR], 1.13; 95% confidence interval [Cl] 1.02–1.37, p = 0.10), body weight change during indwell (OR, 1.00; 95% Cl 0.83–1.18, p = 0.97), and platelet count at TICVAP insertion (OR, 0.98; 95% Cl 0.95–0.99; p = 0.48) showed an increased trend of risk for a stuck catheter. Conclusions We suggest prophylactic catheter exchange before indwell duration of 46 months (area under the curve [AUC], 0.949; 95% Cl 0.905–0.993) and body weight change up to 9.9 kg (AUC, 0.903; 95% Cl 0.840–0.966) to prevent a catheter from becoming stuck, especially in children with rapidly growing acute leukemia. Management of a stuck fragment remains controversial in asymptomatic patients, and we suggest careful, close observation rather than aggressive and invasive treatment.
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Affiliation(s)
- Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea
| | - Joon Yong Cho
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea
| | - Yangki Seok
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Gumi Hospital, Gumi, 39371, Republic of Korea
| | - Youngok Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea.
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Katrancioglu N, Serhatlioglu F, Katrancioglu O. An easy way to remove a stuck hemodialysis catheter. Hemodial Int 2020; 25:E18-E21. [PMID: 33058339 DOI: 10.1111/hdi.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
The replacement of tunneled hemodialysis catheters (CVCs) is a common procedure. In some cases, the CVC cannot be removed from the central vein because of tight adhesions to the surrounding fibrin sheath. A tight fibrin sheath leads to firm adherence between the catheter and the central veins or right atrial wall. Such stuck catheters cannot be removed from the central vein using standard methods. We present here a case demonstrating the successful removal of such a stuck CVC using the reverse Seldinger method.
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Affiliation(s)
- Nurkay Katrancioglu
- Department of Cardiovascular Surgery, Nigde Omer Halisdemir University School of Medicine, 51140 Nigde, Turkey
| | - Faruk Serhatlioglu
- Department of Cardiovascular Surgery, Nigde Omer Halisdemir University School of Medicine, 51140 Nigde, Turkey
| | - Ozgur Katrancioglu
- Department of Thoracic Surgery, Nigde Omer Halisdemir University School of Medicine, 51140 Nigde, Turkey
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7
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Yongchun H, Hua J, Xiaohan H, Jianghua C, Ping Z. Solutions to stuck tunneled cuffed catheters in patients undergoing maintenance hemodialysis. J Vasc Access 2020; 22:203-208. [PMID: 32588722 DOI: 10.1177/1129729820928163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study and discuss treatments for stuck tunneled cuffed catheter in patients undergoing maintenance hemodialysis. METHOD Retrospectively analyzing clinical data of 13 patients with stuck tunneled cuffed catheter in the Kidney Disease Center of the First Affiliated Hospital, College of Medicine, Zhejiang University in the period between September 2012 and October 2018. All patients failed to remove hemodialysis catheters by regular technique. The stuck catheters were treated by thoracotomy, endoluminal percutaneous transluminal angioplasty with blunt dissection or embedded and left in situ. RESULTS In 13 patients, one was successfully treated by thoracotomy, one failed to remove the catheter by regular technique and blunt dissection, and the stump of the catheter was clamped and buried in the subcutaneous fascia of the neck, and the other 11 were treated by endoluminal percutaneous transluminal angioplasty with blunt dissection. The average time of catheter removal procedure is 25 min, the overall success rate is 92.3%, and the success rate of percutaneous transluminal angioplasty is 100%. CONCLUSION Thoracotomy is an efficient way to treat stuck catheter but is limited by its high risk and complications. Leaving part of catheter in situ may increase the risk of central vein stenosis. Comparing to the former two, endoluminal percutaneous transluminal angioplasty is a safe, efficient, and practical way for stuck catheters and should be recommended as the first choice.
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Affiliation(s)
- He Yongchun
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Jiang Hua
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Huang Xiaohan
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Chen Jianghua
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Zhang Ping
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
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8
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Emced K. Intervention of rarely seen catheter loss during permanent tunneled hemodialysis catheterization: A case report. SANAMED 2020. [DOI: 10.24125/sanamed.v15i2.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: In patients with end-stage renal disease (ESRD), permanent hemodialysis catheters are often used by performing percutaneous catheterization to create a permanent vascular access. To the best of our knowledge, no cases with accidental loss of catheter piece during hemodialysis catheter replacement or during its retrieval under scopy has been reported in the literature yet. Case report: It was decided to retrieve the right permanent dialysis catheter of a 54-year-old woman, who had received a temporary dialysis catheter due to the development of catheter site infection in her 3rd permanent catheter (the first two were changed due to thrombosis). Due to excess adhesion in the region, the retrieval of the catheter was complicated, only half of it (proximal piece after cutting into two) was removed, while the distal section slipped and migrated to the right subclavian vein, up to the right atrium. The diagnosis was confirmed by chest radiographs showing that the distal piece of the catheter piece was in the right subclavian vein and right atrium. The catheter piece was retrieved through a minor invasive procedure made possible by scopy without any further complications. Conclusion: Permanent dialysis catheters should ideally be placed under scopy. Also, when the retrieval of a catheter is planned, cutting from any part of the catheter should never be performed.
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9
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Spanish Clinical Guidelines on Vascular Access for Haemodialysis. Nefrologia 2018; 37 Suppl 1:1-191. [PMID: 29248052 DOI: 10.1016/j.nefro.2017.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022] Open
Abstract
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.
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Xu LY, Qi F, Chen L, Chen DJ, Liu MM. Removal of a Stuck Tunneled Central Venous Catheter with the Assistance of Endoluminal Double Balloon Dilatation. Cardiovasc Intervent Radiol 2018; 41:360-362. [DOI: 10.1007/s00270-017-1804-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 09/21/2017] [Indexed: 11/30/2022]
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Hong JH. An Easy Technique for the Removal of a Hemodialysis Catheter Stuck in Central Veins. J Vasc Access 2018; 11:59-62. [DOI: 10.1177/112972981001100112] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Central venous catheters are currently used for long-term hemodialysis (HD) in a large number of patients. When the catheter needs to be removed, the removal is usually achieved without difficulty after dissection of the cuff from the tunnel. However, when the catheter is stuck in the central vein, the removal becomes complex or unsuccessful. Herein, a simple and easy technique is described for the removal of an HD catheter stuck in the central vein. Case Report Attempts were made to remove an HD catheter from a 65-year-old male by making an incision in the skin over the exit site of the catheter to dissect the cuff from the tunnel and by pulling the catheter, but without success because the catheter was stuck in the central vein. Through a second skin incision in the neck, the subcutaneous portion of the catheter was retrieved from the tunnel and then an introducer sheath was inserted over the catheter into the internal jugular vein while the catheter was held in place. The sheath was advanced around the catheter into the central vein. The catheter was then easily pulled out from the central vein. Comment The reported cases of stuck catheters in the literature were reviewed to acknowledge the difficulties encountered in the removal attempts. The technique described herein can be used for the removal of a variety of catheters and wires stuck in the central vein.
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Affiliation(s)
- Joon H. Hong
- Department of Surgery, State University of New York, Downstate Medical Center, New York - USA
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12
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Ahmed J, Tutone VK, Hawkins SP. Successful removal of stuck and infected haemodialysis catheter via endoluminal balloon dilatation after unsuccessful surgical cut-down. Nephrology (Carlton) 2017; 23:93-94. [PMID: 29250920 DOI: 10.1111/nep.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/19/2016] [Accepted: 01/03/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Jafar Ahmed
- Department of Renal Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Viliami K Tutone
- Department of Renal Medicine, Middlemore Hospital, Auckland, New Zealand
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Comments on a stripping method to remove stuck catheter and a plea to adopt large size hemodialysis catheters. J Vasc Access 2017; 19:103-104. [PMID: 29147996 DOI: 10.5301/jva.5000814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Ghahremani-Ghajar M, Jin A, Borghei P, Chen JLT. An unusual case of an irretrievable hemodialysis catheter in a patient with end stage renal disease. Hemodial Int 2017; 22:E1-E5. [DOI: 10.1111/hdi.12584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mehrdad Ghahremani-Ghajar
- Division of Nephrology and Hypertension, Department of Medicine; University of California Irvine; Orange USA
- Nephrology Section, Medical Health Care Group; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
| | - Anna Jin
- Division of Nephrology and Hypertension, Department of Medicine; University of California Irvine; Orange USA
- Nephrology Section, Medical Health Care Group; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
| | - Peyman Borghei
- Department of Interventional Radiology; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
| | - Joline L. T. Chen
- Division of Nephrology and Hypertension, Department of Medicine; University of California Irvine; Orange USA
- Nephrology Section, Medical Health Care Group; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
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Talreja H, Ryan SE, Graham J, Sood MM, Hadziomerovic A, Clark E, Hiremath S. Endoluminal dilatation for embedded hemodialysis catheters: A case-control study of factors associated with embedding and clinical outcomes. PLoS One 2017; 12:e0174061. [PMID: 28346468 PMCID: PMC5367692 DOI: 10.1371/journal.pone.0174061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the increasing frequency of tunneled hemodialysis catheter use there is a parallel increase in the need for removal and/or exchange. A small but significant minority of catheters become embedded or 'stuck' and cannot be removed by traditional means. Management of embedded catheters involves cutting the catheter, burying the retained fragment with a subsequent increased risk of infections and thrombosis. Endoluminal dilatation may provide a potential safe and effective technique for removing embedded catheters, however, to date, there is a paucity of data. OBJECTIVES 1) To determine factors associated with catheters becoming embedded and 2) to determine outcomes associated with endoluminal dilatation. METHODS All patients with endoluminal dilatation for embedded catheters at our institution since Jan. 2010 were included. Patients who had an embedded catheter were matched 1:3 with patients with uncomplicated catheter removal. Baseline patient and catheter characteristics were compared. Outcomes included procedural success and procedure-related infection. Logistic regression models were used to determine factors associated with embedded catheters. RESULTS We matched 15 cases of embedded tunneled catheters with 45 controls. Among patients with embedded catheters, there were no complications with endoluminal dilatation. Factors independently associated with embedded catheters included catheter dwell time (> 2 years) and history of central venous stenosis. CONCLUSION Embedded catheters can be successfully managed by endoluminal dilatation with minimal complications and factors associated with embedding include dwell times > 2 years and/or with a history of central venous stenosis.
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Affiliation(s)
- Hari Talreja
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen Edward Ryan
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet Graham
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adnan Hadziomerovic
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Clark
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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Application of Hong's technique for removal of stuck hemodialysis tunneled catheter to pacemaker leads. Radiol Case Rep 2016; 12:97-101. [PMID: 28228889 PMCID: PMC5310388 DOI: 10.1016/j.radcr.2016.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/22/2016] [Indexed: 11/22/2022] Open
Abstract
The term “stuck catheter” refers to situations where a central venous catheter cannot be removed from the central veins or right atrium using standard technique, usually due to development of a fibrin sheath leading to adherence to SVC or right atrial wall. Endoluminal dilatation is an interventional radiology technique that has been previously reported in the removal of stuck hemodialysis catheters, and to the best of our knowledge, this case describes the first application of the technique to remove a hemodialysis catheter that was adherent to SVC wall and transvenous pacemaker leads.
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Miller LM, MacRae JM, Kiaii M, Clark E, Dipchand C, Kappel J, Lok C, Luscombe R, Moist L, Oliver M, Pike P, Hiremath S. Hemodialysis Tunneled Catheter Noninfectious Complications. Can J Kidney Health Dis 2016; 3:2054358116669130. [PMID: 28270922 PMCID: PMC5332086 DOI: 10.1177/2054358116669130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.
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Affiliation(s)
- Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Pamela Pike
- Department of Medicine, Memorial University, Saint John's, Newfoundland and Labrador, Canada
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Garcarek J, Gołębiowski T, Letachowicz K, Kusztal M, Szymczak M, Madziarska K, Jakuszko K, Zmonarski S, Guziński M, Weyde W, Klinger M. Balloon Dilatation for Removal of an Irretrievable Permanent Hemodialysis Catheter: The Safest Approach. Artif Organs 2015; 40:E84-8. [DOI: 10.1111/aor.12643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jerzy Garcarek
- Department of Radiology; Wroclaw Medical University; Wroclaw Poland
| | - Tomasz Gołębiowski
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Katarzyna Jakuszko
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Sławomir Zmonarski
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Maciej Guziński
- Department of Radiology; Wroclaw Medical University; Wroclaw Poland
| | - Wacław Weyde
- Department of Faculty of Dentistry; Wroclaw Medical University; Wroclaw Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
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The Stuck Catheter: A Hazardous Twist to the Meaning of Permanent Catheters. J Vasc Access 2015; 16:289-93. [DOI: 10.5301/jva.5000392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Permanent central venous catheter use is associated with significant complications that often require their timely removal. An uncommon complication is resistant removal of the catheter due to adherence of the catheter to the vessel wall. This occasionally mandates invasive interventions for removal. The aim of this study is to describe the occurrence of this “stuck catheter” phenomenon and its consequences. Methods A retrospective review of all the removed tunneled hemodialysis catheters from July 2005 to December 2014 at a single academic-based hemodialysis center to determine the incidence of stuck catheters. Data were retrieved from a prospectively maintained computerized vascular access database and verified manually against patient charts. Results In our retrospective review of tunneled hemodialysis catheters spanning close to a decade, we found that 19 (0.92%) of catheters were retained, requiring endovascular intervention or open sternotomy. Of these, three could not be removed, with one patient succumbing to catheter-related infection. Longer catheter vintage appeared to be associated with ‘stuck catheter’. Conclusions Retention of tunneled central venous catheters is a rare but important complication of prolonged tunneled catheter use that nephrologists should be aware of. Endoluminal balloon dilatation procedures are the initial approach, but surgical intervention may be necessary.
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Forneris G, Savio D, Quaretti P, Fiorina I, Cecere P, Pozzato M, Trogolo M, Roccatello D. Dealing with stuck hemodialysis catheter: state of the art and tips for the nephrologist. J Nephrol 2014; 27:619-25. [DOI: 10.1007/s40620-014-0150-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
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21
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Arnáiz-García ME, Gutiérrez-Diez F, Arnáiz-García AM, Arnáiz J, Expósito V, Nistal JF, Rodríquez-Entem F, Olalla JJ, López-Rodríguez J, González-Santos JM. Successful retrieval of an irretrievable jugular tesio catheter using a fogarty arterial embolectomy catheter. Vasc Endovascular Surg 2014; 48:349-51. [PMID: 24407507 DOI: 10.1177/1538574413518614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Long life expectancy and wide development of therapies have increased the number of patients under artificial treatment for lost kidney function or dialysis. Different options for vascular access are suitable for receiving this therapy. The use of tunneled catheters has consequently increased complications related to its use. A difficult retrieval of catheters caused by a hard fibrin sheath along its trajectory is a common drawback. Herein, we report a woman with suspicion of hemodialysis catheter infection and an irretrievable Tesio catheter. A novel technique using a Fogarty arterial catheter allowed a successful retrieval and avoided an aggressive management.
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22
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A Refinement of Hong's Technique for the Removal of Stuck Dialysis Catheters: An Easy Solution to a Complex Problem. J Vasc Access 2013; 15:183-8. [DOI: 10.5301/jva.5000186] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 11/20/2022] Open
Abstract
Aim A long-term tunneled hemodialysis catheter can be difficult or impossible to pull out if a fibrin sleeve has attached it to the venous wall. We report the outcome of a refinement of Hong's technique for removing incarcerated catheters aimed at improving its feasibility and safety. Methods We applied a modification of Hong's technique in four patients (two males, age ranging from 51 to 68 years) with jugular twin hemodialysis catheters (five of eight lines incarcerated). Hong pioneered the technique of endoballooning to expand a stuck central venous catheter, thus freeing it from adhesions. In our technical refinement, we cut the catheter close to its venous entry point in order to facilitate pullout and inserted a valved introducer as access for guide wires as well as for inflations of the catheter balloon. A stiff guide wire was placed in the inferior vena cava to avoid potential damage to heart cavities. Dilation was monitored under fluoroscopy with constrictions showing points where the catheter was incarcerated. If adhesions persisted through the same introducer, endoluminal dilations were repeated with a larger diameter balloon until the catheter was released. New catheters can be positioned using the stiff guide wire already in place. All removals were carried out under local anesthesia in an angiographic room by interventional radiologists. Results All catheters were successfully removed without complications. Average fluoroscopy time for removal was 12 minutes. In the case of a Tesio catheter removed after 12 years because of infection, a computed tomography scan 2 months later revealed persistence of a calcified fibrin sleeve in the vessel. Conclusions Hong's technique was confirmed to be a simple, safe and highly effective way to remove incarcerated long-term central venous catheters. The refinements we adopted made the procedure more flexible and possibly less prone to complications. By properly using ordinary tools available anywhere, Hong's technique could be considered Columbus’ egg in this previously risky field.
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23
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Chan BKY, Rupasinghe SN, Hennessey I, Peart I, Baillie CT. Retained central venous lines (CVLs) after attempted removal: an 11-year series and literature review. J Pediatr Surg 2013; 48:1887-91. [PMID: 24074662 DOI: 10.1016/j.jpedsurg.2013.01.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 01/09/2013] [Accepted: 01/26/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Central venous lines (CVLs) are frequently used in the management of many neonatal and pediatric conditions. Failure to remove the luminal part of the line (retained CVL) is rare. Consequently, there is lack of experience and consensus in its optimal management. AIM To document the incidence and management of retained CVLs in a tertiary pediatric surgical centre with access to interventional cardiology services. To review the literature and report efficacy/morbidity of attempted extraction of retained CVLs. METHODS Children with retained CVLs were identified from departmental morbidity and mortality records over an 11-year period. A literature search was performed in PubMed and Scopus to identify studies reporting retained CVLs (earliest date to 1 January 2012). This was supplemented by scanning bibliographies of retrieved articles. RESULTS The 11-year incidence of retained CVL was 0.3% (n=10; median duration in-situ 66.5 {range 47-146} months). The underlying pathology in 8 was cystic fibrosis. Antegrade transfemoral snare retrieval was successful in 6 of 7 attempts. In the remaining 3, a conservative approach was adopted following consultation with the family. None of the 4 with retained CVL developed complications (median follow-up 7.5 {range 1-53} months). The literature describes 38 pediatric index cases (including 10 from the current series). Seventeen (49%) were managed conservatively either intentionally or by default after failed endovascular removal attempt (n=4). No complications directly attributed to retained CVLs have been reported (median follow-up 40 {range 1-120} months). Reported morbidity associated with endovascular retrieval includes: procedural failure 30%, line embolization 8%, and intra-operative thrombo-embolism 8%. CONCLUSION Literature regarding management of retained CVLs is anecdotal. Although uncommon, the complication should feature in consent for removal of CVLs. Conservative management carries long-term risks of infection, thrombosis, and even migration, albeit unquantified over a child's lifetime. Endovascular retrieval is feasible with appropriate expertise.
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Affiliation(s)
- B K Y Chan
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool L12 2AP, United Kingdom.
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24
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Imaging and management of complications of central venous catheters. Clin Radiol 2013; 68:529-44. [PMID: 23415017 DOI: 10.1016/j.crad.2012.10.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/10/2012] [Accepted: 10/16/2012] [Indexed: 11/23/2022]
Abstract
Central venous catheters (CVCs) provide valuable vascular access. Complications associated with the insertion and maintenance of CVCs includes pneumothorax, arterial puncture, arrhythmias, line fracture, malposition, migration, infection, thrombosis, and fibrin sheath formation. Image-guided CVC placement is now standard practice and reduces the risk of complications compared to the blind landmark insertion technique. This review demonstrates the imaging of a range of complications associated with CVCs and discusses their management with catheter salvage techniques.
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25
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Endoluminal Dilation Technique to Remove “Stuck” Tunneled Hemodialysis Catheters. J Vasc Interv Radiol 2012; 23:1089-93. [DOI: 10.1016/j.jvir.2012.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 03/31/2012] [Accepted: 04/07/2012] [Indexed: 11/22/2022] Open
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26
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Balloon Dilatation: A Helpful Technique for Removal of a Stuck Dialysis Line. Cardiovasc Intervent Radiol 2012; 35:1528-30. [DOI: 10.1007/s00270-012-0365-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 01/29/2012] [Indexed: 10/28/2022]
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27
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A Breakthrough Technique for the Removal of a Hemodialysis Catheter Stuck in the Central Vein: Endoluminal Balloon Dilatation of the Stuck Catheter. J Vasc Access 2011; 12:381-4. [DOI: 10.5301/jva.2011.8415] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2011] [Indexed: 11/20/2022] Open
Abstract
Background Hemodialysis (HD) catheters can get stuck in the central vein after long-term use and their removal might become difficult especially in patients with fibrosed or occluded central veins. Herein, a breakthrough technique is reported for the easy removal of a stuck HD catheter from the central vein. Case Report Attempts were made to remove a tunneled double-lumen HD catheter from the central vein of a 74-year-old woman, only to find that the catheter was stuck. The patient was transferred to the operating room and a skin incision was made in the neck and the subcutaneous portion of the HD catheter was retrieved from the tunnel. Under fluoroscopy, a guide wire was inserted into one lumen of the HD catheter and advanced into the right atrium beyond the catheter tip. A 5 mm × 4 cm balloon angioplasty catheter was then inserted into the HD catheter lumen over the guide wire and advanced into the jugular vein junction of the HD catheter around the thoracic inlet. The balloon was inflated to its maximum dimension and pressure. This endoluminal dilatation of the HD catheter was continued by deflating the balloon and then pushing the angioplasty catheter 4 cm at a time towards the tip of the HD catheter in the right atrium. After a second balloon angioplasty catheter of 6 mm × 4 cm was used to expand the entire segment of the other lumen, the HD catheter was pulled out easily from the central vein without any resistance. Comments The endoluminal balloon dilatation of the HD catheter not only separates the stuck HD catheter from the adherent vein by breaking the adhesions between them, but also expands the vein simultaneously, thus enabling easy removal of the HD catheter.
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28
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Reddy A, Stangl A, Radbill B. Retained Catheter Fragment from a Fractured Tunneled Catheter-A Rare and Potentially Lethal Complication. Semin Dial 2010; 23:536-9. [DOI: 10.1111/j.1525-139x.2010.00756.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Webb ST, Parikh MK. Central Venous Catheter Guidewire Entrapment: Percutaneous Removal Using a Pulmonary Artery Catheter Introducer Sheath. J Intensive Care Soc 2010. [DOI: 10.1177/175114371001100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Stephen T Webb
- Stephen T Webb Consultant in Anaesthesia and Intensive Care Medicine
| | - Manoj K Parikh
- Manoj K Parikh Clinical Fellow in Cardiothoracic Anaesthesia Papworth Hospital NHS Foundation Trust, Cambridge, UK
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30
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Carrillo RG, Garisto JD, Salman L, Merrill D, Asif A. A Novel Technique for Tethered Dialysis Catheter Removal Using the Laser Sheath. Semin Dial 2009; 22:688-91. [DOI: 10.1111/j.1525-139x.2009.00646.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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