Complete knotting of a catheter and a nonsurgical method of removal

Knots in the cath lab, an embarrassing complication of radial angiography

Most case reports or series describe knots in the venous system such as knots of Swan-Ganz catheters, pacing wires or thermodilution catheters. Knots during radial angiography are relatively rare. Here we describe a simple method of unravelling a radial knot via the femoral route, together with a review of the literature on knots in the catherisation laboratory and the techniques to deal with them.

Transesophageal echocardiographic diagnosis of intracardiac entrapment of a Swan-Ganz catheter in open heart operation

A Swan-Ganz catheter entrapment by a suture in the right atrial wall during open heart operation is presented. The diagnosis of the suture entrapment of the Swan-Ganz catheter to the right atrial wall was established by direct observation of the specific movement pattern of the cardiac structures when manual traction was applied from outside by a transesophageal echocardiographic examination.

Removal of knotted intravascular devices. Case report and review of the literature

OBJECTIVE

to review published reports on knotted intravascular devices/catheters.

METHOD

report of two cases and systematic review of the literature.

RESULTS

a total of 113 reported cases of knotted intravascular devices/catheters were located. Pulmonary artery catheters (Swan-Ganz) were responsible for more than two thirds of the total reported intravascular knots. In 62% (70/113) of the cases withdrawal of the knotted catheters was achieved successfully with different interventional radiological techniques, avoiding the need for surgical exploration. In 32% (36/113) of the patients surgical removal was favoured. Capture with one of the interventional techniques and pulling down the knot into an easily accessible vein to be removed through an open venotomy, was the most common surgical procedure. However, in five cases, an open cardiotomy was required. In seven cases the patient's condition was critical and precluded any surgical procedure, so the knotted catheter was left in situ. The mortality of this event was 8% (9/113).

CONCLUSIONS

interventional radiological techniques have largely replaced open surgical removal. Knotted catheters may need to be surgically removed when (a) the knot is large in size with many loops, or (b) intracardiac fixing of the knot is encountered.

Percutaneous untying of a knot in a retained Swan-Ganz catheter

A patient was referred to us with a tightly knotted Swan-Ganz catheter. The catheter could not be removed by conventional simple methods. We describe a minimally invasive means of removal of the catheter using an Amplatz gooseneck snare and an angioplasty balloon. This allowed the catheter to be removed without trauma.

Snare loop technique for removal of broken steerable PTCA wire

Two cases are described of percutaneous removal of trapped, broken steerable PTCA guidewire. One case described breakage of a guidewire inside the ascending aorta leaving a free end, which is retrieved using the snare loop technique. The second case described retrieval of an intact yet unwound wire through the guiding catheter using a snare loop wire.

Knotting and entanglement of multiple central venous catheters

A 53-yr-old black male was admitted with peripheral vascular disease and septic shock. Appropriate cardiopulmonary resuscitation and operative intervention required the placement of multiple central venous lines. These included two subclavicular central venous pressure (CVP) catheters and one Swan-Ganz catheter (SGC). During manipulation of the SGC, it formed a knot with the two CVP catheters entangled in it. After consideration of the variety of strategies that could be employed, the CVP catheters were manually disengaged from the knot and the knot was surgically removed. The increasing frequency and multiple central angioaccess catheters will result in a finite increase in the nature and complexity of the clinical challenges. The insistence on the use of multiple single-channel catheters for separate therapeutic functions and the duration of stay of pulmonary catheters should be reconsidered.

Knotting of intracardiac flow-directed balloon catheter. Simple surgical method of removal

A complete knot occurred in a 7F flow-directed balloon catheter inserted through the right internal jugular vein. The patient was intubated and placed under positive pressure ventilation. After gaining surgical exposure of the venipuncture site, a purse-string of Prolene 4--0 suture was placed around it. The patient was placed in the Trendelenburg position and the knotted catheter withdrawn, while the purse-string suture was immediately tightened avoiding uncontrollable hemorrhage or massive air embolism.

Knotted ventriculoatrial catheter. Case report

In this patient a No. 5 French infant feeding tube was advanced through the right basilic vein into the superior vena cava, and became knotted around the end of an atrial catheter placed in the left common facial vein. The atrial catheter stretched sufficiently to allow excision of the knot as it came through the antecubital incision. It then snapped back up into the axillary vein. A shuntgram with 60% Renograffin demonstrated the position of the ventriculoatrial catheter in the axillary vein. Subsequently, the catheter slid back into the atrial position.

Knotting of central venous catheters: nonsurgical correction

A complete knot occurred in a central venous catheter inserted through the subclavian vein. By passing a spring guidewire into the catheter under fluoroscopic control, the knot was easily untied leaving the catheter correctly in place.

Knotting of a flow-directed catheter about a cardiac structure

An instance of knotting of a flow-directed catheter about an intracardiac structure, presumably part of the tricuspid valve apparatus, is described. Because of the patient's severe pulmonary disease, cardiac surgery to remove the catheter was contraindicated. The central portion of the catheter was allowed to remain in situ, without apparent ill effects over a 16 month period.

A technique for unknotting an intracardiac flow-directed balloon catheter

Described is an unusual complication occurring during right-sided cardiac catheterization using a 7F flow-directed balloon catheter. During an attempt to direct the catheter from the main pulmonary artery into the pulmonary wedge position, the tip became entangled in a loop of catheter and knotted. Initially, all attempts to unknot or remove the catheter failed. A movable core guide wire was passed through the major lumen of the catheter, resulting in the immediate unknotting of the catheter, thus allowing its withdrawal.