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Takahashi K, Arai T, Asai T, Okuda Y. A fragmented segment of a central venous catheter caused delayed ventricular fibrillation: a case report. JA Clin Rep 2023; 9:27. [PMID: 37193904 DOI: 10.1186/s40981-023-00615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Central venous port systems may be safely used for chemotherapy of patients with cancer, but several complications may occur associated with their use. CASE PRESENTATION An 83-year-old man with heat stroke was transferred to our emergency department, where he was treated and became able to eat on the same day. He had been fit and healthy, except for colorectomy and chemotherapy using a central venous access port placed in the right upper jugular vein 8 years ago. The next day, he suddenly had ventricular fibrillation. Cardiopulmonary resuscitation was successful. Emergency coronary angiography showed a catheter-like foreign body in the coronary sinus. Physicians failed to remove the foreign body using catheter therapy, and ventricular fibrillation occurred repeatedly. After induction of general anesthesia, the fractured catheter was removed surgically. Postoperative course was uneventful. CONCLUSIONS A fragmented segment of a catheter may suddenly cause ventricular fibrillation years later.
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Affiliation(s)
- Kei Takahashi
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan.
| | - Takero Arai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Yasuhisa Okuda
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
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Sudhakar B, Teja BR. Successful recovery of central venous catheter fragment from coronary venous sinus and right ventricle: A case report. Radiol Case Rep 2021; 16:2261-2265. [PMID: 34188739 PMCID: PMC8220104 DOI: 10.1016/j.radcr.2021.03.064] [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: 01/18/2021] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022] Open
Abstract
Catheter fracture with subsequent embolization is a well known but a potentially serious late complication of central venous catheter placement. Central venous catheters are frequently implanted for the purpose of chemotherapy and parenteral nutrition. Most common vein used for the placement of central venous catheter is subclavian vein. According to case reports, catheter placed in subclavian vein is vulnerable for fracture and is often preceded by the "pinch-off sign", first described by Aikten and Minton. It is due to shearing forces between the clavicle and first rib. Broken catheter frequently embolises to Right atrium, Right Ventricle, Inferior vena cava, Pulmonary arteries and rarely into Coronary sinus. Migration to Coronary sinus is very uncommon and only 5 cases are reported in the literature as of now. We are presenting an unusual case where chemoport catheter severed and lodged partly in coronary venous sinus and partly in right ventricle taking a "U "shape. Fragment was successfully retrieved percutaneously using a snare after straightening it with a pigtail catheter. Though majority of patients deny symptoms however, some do have symptoms or complications. Catheter fragment can lead to arrhythmias, thrombosis, infection and perforation. Thrombosis of coronary sinus is a life threatening complication. Regular follow up with Chest x ray may recognize the fracture and embolization much earlier. In almost all cases the migrated portion can be retrieved safely percutaneously without recourse to surgery.
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Affiliation(s)
- B.G.K. Sudhakar
- Consultant Cardiologist, KIMS hospital, Secunderabad, Telangana 500003 India
| | - B. Ravi Teja
- Fellow in cardiology, KIMS hospital, Secunderabad, Telangana, India
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Ding X, Ding F, Wang Y, Wang L, Wang J, Xu L, Li W, Yang J, Meng X, Yuan M, Chu J, Ge F, Dong W, Xue M. Shanghai expert consensus on totally implantable access ports 2019. J Interv Med 2019; 2:141-145. [PMID: 34805890 PMCID: PMC8562251 DOI: 10.1016/j.jimed.2019.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Totally implantable access ports (TIAPs) are used for patients with poor peripheral vascular support requiring central venous access. In recent years, TIAPs have been gradually accepted and promoted by patients, doctors, and nurses owing to their advantages of convenient carrying, a long maintenance period, low complications, and a high quality of life for patients. Currently, medical personnel that handle TIAP implantation and management in China are from different areas of healthcare, including surgery, internal medicine, radiology, nurse anesthesia, vascular access, etc., and many only handle TIAP as a part of their duties. Therefore, the operating procedures and steps for the diagnosis and treatment of complications of TIAP vary from person to person, resulting in different incidence and treatment methods for complications in the implantation and use of TIAP in different medical units. Based on this, we have updated the Shanghai expert consensus on TIAPs from 2015 and explored the diagnosis and treatment procedures of related complications while continuing to emphasize standardized implantation and maintenance.
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Affiliation(s)
- Xiaoyi Ding
- Ruijin Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Fang Ding
- Sixth People's Hospital Affiliated with Shanghai Jiaotong University, Shanghai, 200233, China
| | - Yonggang Wang
- Sixth People's Hospital Affiliated with Shanghai Jiaotong University, Shanghai, 200233, China
| | - Liying Wang
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jianfeng Wang
- Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Lichao Xu
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wentao Li
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jijin Yang
- Changhai Hospital Affiliated with The Second Military Medical University, Shanghai, 200433, China
| | - Xiaoxi Meng
- Changzheng Hospital Affiliated with The Second Military Medical University, Shanghai, 200003, China
| | - Min Yuan
- Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai, 200083, China
| | - Jun Chu
- Shanghai Children's Medical Center Affiliated with Shanghai Jiaotong University, Shanghai, 200025, China
| | - Feng Ge
- Zhongshan Hospital Affiliated with Fudan University, Shanghai, 200032, China
| | - Weihua Dong
- Changzheng Hospital Affiliated with The Second Military Medical University, Shanghai, 200003, China
| | - Mei Xue
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shanghai Cooperation Group on Central Venous Access Vascular Access Committee of the Solid Tumor Theranostics Committee, Shanghai Anti-Cancer Association
- Ruijin Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
- Sixth People's Hospital Affiliated with Shanghai Jiaotong University, Shanghai, 200233, China
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
- Changhai Hospital Affiliated with The Second Military Medical University, Shanghai, 200433, China
- Changzheng Hospital Affiliated with The Second Military Medical University, Shanghai, 200003, China
- Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai, 200083, China
- Shanghai Children's Medical Center Affiliated with Shanghai Jiaotong University, Shanghai, 200025, China
- Zhongshan Hospital Affiliated with Fudan University, Shanghai, 200032, China
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Lukito AA, Pranata R, Huang I, Thengker A, Wirawan M. Fracture of the Port Catheter and Migration Into the Coronary Sinus: Case Report and Brief Review of the Literature. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619832282. [PMID: 30833817 PMCID: PMC6393817 DOI: 10.1177/1179547619832282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/14/2019] [Indexed: 12/16/2022]
Abstract
Introduction: Totally implantable venous device has a good safety profile, although certain complications may occur. Late mechanical complications include catheter fracture and cardiac migration which are rarely occurring in approximately 0.1% to 1% of patients. Case presentation: A 33-year-old woman referred by the surgical oncologist for port catheter fragment extraction through endovascular approach. She was asymptomatic on presentation and has a history of hypertension and smoking. Chest X-ray showed a port catheter fragment previously thought to be in the right atrium at the level of 8-9 thoracic vertebrae (right heart catheterization showed that the port catheter fragment was in the coronary sinus). Angiography of the right outflow tract indicates that the fragment was not in the outflow tract or pulmonary arteries but posterior to it. It was concluded that the port catheter fragment had migrated deep into the coronary sinus and the snare was unable to pull the fragment. It was deemed unfeasible to remove the fragment through the endovascular approach. Discussion: The port catheter fracture had migrated entirely into the coronary sinus and to the deep of our knowledge; this was the fourth case reported in the current literature. We tried to do a review of previous similar case reports; interestingly, this was the only case where the fragmented catheter was situated deep within the coronary sinus without any part of the fragment projected to the right atrium. This made the retrieval of the fragment much more difficult with a high chance of failure. Conclusions: Migration of totally implantable venous device into coronary sinus is a rare but possible complication and might be difficult to remove if the position is unfavorable.
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Affiliation(s)
- Antonia Anna Lukito
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Ian Huang
- Department of Internal Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Alvin Thengker
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Marco Wirawan
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
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Pignataro BS, Nishinari K, Wolosker N, Bomfim GAZ. Fracture and migration into the coronary sinus of a totally implantable catheter introduced via the right internal jugular vein. BMJ Case Rep 2014; 2014:bcr-2014-207276. [PMID: 25452299 DOI: 10.1136/bcr-2014-207276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
There has been an increase in the use of totally implantable devices. Catheter fractures are rare but known complications. This case report presents a rare migration site of the catheter fragment into the coronary sinus. The totally implantable catheter was introduced into the right internal jugular vein to deliver chemotherapy. Although it was an unusual site, the catheter fragment was removed without complications using loop-snare technique.
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