Peripheral venous catheter fracture with embolism into the pulmonary artery

Surgical removal of a peripheral venous catheter fragment in the heart in a preterm infant

Peripheral venous catheter fracture with cardiovascular embolization is a rare but potentially serious complication. Herein, we report a case of peripheral venous catheter fracture with embolization in right ventricle in a preterm infant. The catheter fragment was successfully removed by surgical procedure via median sternotomy under cardiopulmonary bypass(CPB).We hope this case will increase awareness of this rare complication and improve cannulation safety.

Value of multiplanar reconstruction in multi-slice computed tomography for the detection of foreign body in the pulmonary artery: a case report

Multi-slice computed tomography (MSCT) is the primary method for the detection and visualization of foreign bodies in the pulmonary artery because it provides high sensitivity and accuracy. It is very difficult to diagnose a patient with a non-iatrogenic pulmonary artery foreign body who does not have a history of a penetrating trauma. This case report describes a 36-year-old male that presented with coughing and haemoptysis. Based on conventional coronal and cross-sectional CT, the foreign body was misdiagnosed as pulmonary tuberculosis and pulmonary artery thrombosis. During treatment of the bronchial artery embolization and anti-tuberculosis therapy, the patient continued to experience haemoptysis. After further analysis of the pulmonary artery CT angiography images and curved multiplane reconstruction, an approximately 6-cm long toothpick was identified in the pulmonary artery with an unclear entry route. After surgery to remove the toothpick, symptoms of coughing and haemoptysis were resolved. This current case demonstrated that multiplane reconstruction in MSCT can improve the detection and visualization of pulmonary artery foreign bodies, which can aid in the diagnosis of pulmonary artery diseases of unknown cause.

Management of accidental fracture and embolization of intravenous cannula in peripheral veins using a novel J- Flap technique: A case series

The use of intravenous cannulas is a common procedure in healthcare. It's a common way of accessing the intravenous route for several purposes in patient care. Procedure is fraught with a significant risk of fracture and embolization of cannula that merits immediate intervention. There is paucity of well-defined techniques in literature for retrieval of such fractured cannulas from peripheral veins. A case series highlighting the use of a novel J-flap surgical technique in the management of fractured intravenous cannula in six (6) adult patients by the authors over a 24-month period. The intervention reduces or eliminates the risk of central embolization with its attendant severe consequences and invasive intervention. The learning curve of the technique seems gentle and does not need sophisticated surgical instrumentation.

Rescue of a patient with a 50 cm broken PICC tube retracted and wrapped in pulmonary artery: a case report

Objective

With the increasing use of a peripherally inserted central catheter (PICC) in clinical application, the breaking of the PICC is increasing as well, which would turn into the emboli and drift to the heart and pulmonary artery, causing severe consequences. However, few cases have been reported on the rescue of patients with a broken PICC.

Patient concerns

A 33-year-old man, diagnosed with chronic hepatitis B-related decompensated cirrhosis and cryptococcal meningitis, was treated with amphotericin B combined with flucytosine and fluconazole by means of PICC catheterization. The patient was discharged with a catheter; when he returned for re-examination, a 50cm length of PICC broke and slipped into the vein after his sudden dysphoria. First aid was immediately administered, and then the intervention therapy to extricate the tube, including pulmonary artery angiography and intravascular removal of foreign matter, was performed based on the consensus of the in-hospital vein treatment group. At last, the broken PICC fragment was successfully taken out of the vessel. Re-examination after surgery showed that he recovered well.

Conclusions

Once the catheter is broken, the X-ray examination should be performed at the first instance and re-examined frequently. Moreover, the involvement of a multidisciplinary team should be formed to decide the appropriate method of treatment to ensure a successful rescue.

Pulmonary Embolization of Radiolucent Intravenous Cannula: Endovascular Retrieval

Fracture and embolization of peripheral intravenous cannula is very rare. Although endovascular retrieval is the standard of care for most of the embolized intravascular devices, endovascular management of embolized peripheral intravenous cannula is technically difficult due to its radiolucent nature and it is not described previously in the literature. We describe the clinical presentation, imaging findings, and endovascular management in a middle aged male who had fractured peripheral intravenous cannula which was embolized into the pulmonary artery branch. Technical nuances associated with retrieval of this radiolucent little plastic tube have been discussed.

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

Complications during central venous catheter (CVC) insertion are infrequent with an incidence of 0.1%-1%. We experienced a rare CVC complication with fragmentation of the angiocatheter at its hub during central venous cannulation while utilizing the modified Seldinger technique (ie, wire through the catheter technique). Vascular surgery was emergently required to remove the catheter fragment from the neck. Clinicians must remain vigilant during all aspects of CVC insertion, including awareness of the potential for fragmentation of the angiocatheter during its removal over the in situ guidewire. Prompt recognition and appropriate management included leaving the guidewire in place (to stabilize the distal fragmented segment) and promptly consulting vascular surgery for removal before potential vascular embolization of the angiocatheter fragment. We further recommend that all components of the insertion kit be inspected before and after patient use.

A strange case of foreign body embolism in the right lower pulmonary artery

Foreign bodies in the pulmonary circulation have been documented in the literature, with almost all cases being iatrogenic, involving venous catheters, or due to penetrating foreign body emboli. Foreign body pulmonary emboli are often difficult to diagnose due to their varied clinical presentation, the nature of the embolizing material and dubious radiological features. We describe the case of a patient who experienced episodes of massive hemoptysis with inconclusive radiological findings, who underwent a thoracotomy with the discovery of a wooden object of 7 cm in length in the right lower lobe artery, with no apparent mechanism of injury.

A missing piece: Fracture of peripheral intravenous cannula, a case report

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Cannulation is a benign procedure with potential complications.

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Fracture of a peripheral intravenous cannula in situ is rare, and can lead to proximal migration sepsis, dysrhythmias, and mortality.

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We propose reinsertion of guide needle as an etiological factor for fracture of peripheral intravenous cannula.

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Understanding this mechanism allows for safer cannulation practices.

Introduction and importance

Peripheral venous cannulation is the most common procedure, often performed by junior colleagues. Despite its benign nature, it is associated with extravascular infiltration, thrombophlebitis, hematoma, catheter-associated bloodstream infections, trauma to surrounding structures, including tendon and nerve injures, hematoma formation and air embolism. Fracture of a peripheral intravenous cannula in situ is a rare, potentially serious complication that is underreported. More importantly, the etiology and prevention of this complication are not widely known by those performing cannulation. This case report will increase awareness and knowledge on intravenous peripheral cannula fracture to improve peripheral intravenous cannulation safety.

Case presentation

In this case report, we describe a fracture of a size 18 G plastic peripheral intravenous cannula (Neovac-Neomedic) in situ in a 76-year-old hypertensive male managed at Aga Khan Hospital Dar es salaam, Tanzania. The cannula's fracture was noticed 24 h later during the cannula's removal, where a fragment of the cannula was noted, and a palpable cord-like structure was appreciated along the cubital fossa. Ultrasound was done to localize the distal segment, confirming a cannula fracture with the distal fragment's retention. Surgical exploration under local anesthetic was necessary, retrieving the fragment. There were no intra-operatively or post-operative complications encountered. Proximal migration of the segment risks the chances of developing sepsis, dysrhythmia, and myocardial infarction, but this did not occur in our case.

Clinical discussion

Reinsertion of the guide needle into the plastic sheath in situ most probably caused the fracture. Additional healthcare costs are incurred for investigation, admission, and surgical procedures. The patient experience may be affected by this complication.

Conclusion

Understanding the guide needle's reinsertion may result in cannula fracture, allows safer cannulation practices by the clinician and adequate counseling of the patient before the procedure.

CT-guided retrieval of a fractured intravenous cannula in a toddler: A case report

INTRODUCTION

Fractured cannula is a complication of peripheral intravenous cannula (PIVC) insertion. It is a rare but potentially fatal complication. We present a case of iatrogenic fracture of a PIVC in a toddler.

CASE REPORT

An acutely ill 30-month-old boy presented at the emergency room and a PIVC insertion was attempted several times using the same cannula which fractured in the process. While the main part of the device was recovered, about 7 mm of the cannula was retained in the tissues and was not palpable. Computed tomography was used to locate the foreign body which was surgically removed under general anesthesia.

DISCUSSION

A fractured and retained PIVC, especially when it is not palpable clinically, is an emergency due to possible embolization and the consequent potentially fatal outcome. This case underscores strict adherence to standard guidelines in prevention and the importance of computed tomography in the management of this condition.

A case of needle embolism in a drug abuser, a diagnostic and therapeutic challenge

Background

Needle embolism is a rare complication of intravenous habit. Clinical manifestations include recurrent pericarditis, tamponade, cardiac perforation, and infective endocarditis. We describe the case of needle embolization in a young intravenous opiate abuser.

Case presentation

We describe a rare complication of intravenous misuse in a 23-year-old patient. He presented at the emergency department with chest pain and shortness of breath. He complained of remittent fever ensued 6 months before. Echocardiographic and radiologic images revealed pericardial effusion and a needle fragment inside the pericardium. The needle was removed through left-anterior mini-thoracotomy, after CT-guided carbon tracking.

Conclusions

The presence of a foreign body within the heart resulted from the migration of a needle fragment from a peripheral vessel. It caused fever and recurrent pericarditis. In similar cases, surgical extraction is the therapy of choice.

Removal of a migrating catheter in the retroauricular vein: a case report

A fractured catheter in the posterior auricular vein is exceedingly rare. Imaging revealed that it was migrating freely and currently overlapped the temporal bone. With multidisciplinary cooperation, general anesthesia, and three-dimensional computed tomography (3D-CT) for guidance, the catheter was removed uneventfully.

A foreign body in the blood vessel: A diagnostic and therapeutic dilemma

Foreign body(FB) in soft tissue is a common injury in trauma, but it is rare for FB to enter the blood vessel. Typical causes of intravascular FB include iatrogenic and non-iatrogenic factors.A 65-year-old Chinese worker's left hand was hit by two colliding metal blocks while operating a machine tool. Then, he referred to our hospital's emergency department of orthopedics. The X-rays showed that metal FB could be seen in trapezium bone regions of the left hand. During the operation, the FB was found in the cephalic vein of his left hand, so the FB was removed by surgery. After six weeks of follow-up, he has returned to normal working conditions.The purpose of this article is to describe the diagnosis and treatment of a rare condition in the emergency department. In our emergency work, it is easy to miss the diagnosis of intravascular FB caused by trauma. To our knowledge, this is the third reported intravascular FB caused by trauma and the first reported intravascular FB was located in the vein of the hand. Detailed medical history and auxiliary examinations are the key to the diagnosis of FB in the blood vessels.

Needle Embolization: Suspecting Needle Migration in Intravenous Drug Abusers

BACKGROUND

Thirteen million people inject drugs globally, making intravenous drug abuse a substantial concern worldwide. While intravenous drug users occasionally report the breaking of a needle into the skin or subcutaneous tissue, central needle migration remains a rare but potentially devastating complication.

CASE REPORT

A 27-year-old man with a history of intravenous drug abuse presented to the emergency department with the sudden onset of left-sided neck pain, chills, and subjective fever with a history of needle breaking in his left neck 3 weeks earlier while using heroin. A computed tomography scan of his chest revealed a needle lodged in the right ventricle with associated mediastinitis and mass effect on the left brachiocephalic vein, and a left internal jugular thrombus. Broad-spectrum antibiotics were initiated. This patient was managed nonsurgically for several reasons and was discharged on hospital day 12 with oral antibiotics. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intravenous drug abusers commonly use cervical veins when their peripheral vasculature has become sclerosed. This puts intravenous drug users at increased risk for intravascular embolization. Due to varied symptomology-chest pain, dyspnea, fever, or asymptomatic-and timelines-days, weeks, or months-after reported needle fragmentation, this remains a complex and likely underdiagnosed condition. Case reports describe serious complications of intracardiac needle embolization, such as cardiac perforation, constrictive pericarditis, septic endocarditis, dysrhythmias, granulomas, venous thrombosis, empyema, acute or delayed spontaneous pneumothorax, osteomyelitis, and valvular damage. In this complicated patient population, clinicians should consider needle retention and relocation in patients who report needle breaking or in those who present with chest pain, dyspnea, or fever among other complaints.

Tricuspid Valve Incompetency Due to the Grenade Chip Embolization to the Heart

Migration of foreign bodies into the heart, although unusual, has been reported since 1834 when Davis published the first bullet embolus. Our case was a 29-year-old woman who suffered from a grenade explosion wound with a residual burst fragment inside her arm soft tissue. Two months later, she was admitted with progressive fatigue, palpitation, shortness of breath, and swelling in legs and neck. She was taking hormonal therapy for infertility as medical history. Ascultation detected holosystolic respiratory variable murmur maximal over the left lower sternal border. Severe tricuspid regurgitation and an obliterating mass on tricuspid valve (TV) with characteristic of central linear echogenicity were detected by transthoracic echocardiography. The diagnosis of "the embolized missile into heart with superimposed thrombosis" was determined. The patient underwent open heart surgery and the thrombotic rod shape chip that was embedded in anterior tricuspid leaflet was removed and then TV was repaired.

A foreign body in the cephalic vein: A case report

RATIONALE

Foreign bodies in the vasculature usually cause numerous problems for clinical physicians. Physician experience with diagnosing and treating non-iatrogenic foreign body migration in the venous system is insufficient.

PATIENT CONCERNS

Here, we reported a 41-year-old male who had a foreign body in his left forearm following a work-related injury.

DIAGNOSES

X-ray films indicated a 3-mm high-density shadow in the superficial soft tissue of the left forearm. During the operation, the foreign body was imaged by a C-arm fluoroscope to provide a more accurate location.

INTERVENTIONS

The foreign body was removed completely following a microsuture of the cephalic vein.

OUTCOMES

The procedure was uneventful, and the patient remained asymptomatic after 6 months of clinical follow-up.

LESSONS

This case indicated that the foreign body in the superficial tissue needed to be accurately diagnosed and located. X-ray and C-arm fluoroscope imaging should be combined with the patient's medical history to ensure sufficient preoperative preparation.