Knotting and entanglement of multiple central venous catheters

Secondary migration of a pre-existing central venous catheter due to a Swan-Ganz catheter insertion - A case report

BACKGROUND

The entanglement of multiple central venous catheters is a rare and seriouscomplication. The Swan-Ganz catheter is a responsible for various cases.

CASE

A 66-year-old male patient was under general anesthesia for a coronary artery bypassgraft surgery. As he had a pre-existing Perm catheter in the right subclavian vein, a SwanGanz catheter was inserted into the left internal jugular vein. Chest radiograph after catheterplacement revealed that the Perm catheter had migrated to the left brachiocephalic vein.The surgeon attempted to reposition it manually, but postoperative radiograph showed thatit had rolled into a loop. On postoperative day 1, radiological intervention was performed tountangle the loop, which was successful.

CONCLUSIONS

After placing a Swan-Ganz catheter in patients with a pre-existing central venous catheter, the presence of entanglement should be assessed. In such cases, radiology-guided correction is recommended, as a blind attempt to disentangle can aggravate thecondition.

Spontaneous Knot Formation in a Central Venous Catheter

Patient: Male, 63-year-old

Final Diagnosis: Spontaneous knot formation in central venous catheter

Symptoms: Central venous catheter whit any flow • associated with pain at the insertion site of the access

Medication: —

Clinical Procedure: Central venous catheterization

Specialty: General and Internal Medicine • Surgery

Central Line Catheters and Associated Complications: A Review

The use of a central line or central venous catheterization was brought to attention in 1929 when Dr. Werner Forssmann self-inserted a ureteric catheter through his cubital vein and into the right side of his heart. Since that time the central line technique has developed further and has become essential for the treatment of decompensating patients. Central lines are widely used for anything from rapid fluid resuscitation, to drug administration, to parenteral nutrition, and even for administering hemodialysis. Central lines come in different sizes, types, and sites of administration. Sometimes their use can be associated with complications as well. The following review article addresses these parameters of central lines and goes into detail regarding their complications.

Central line complications

Central venous access is a common procedure performed in many clinical settings for a variety of indications. Central lines are not without risk, and there are a multitude of complications that are associated with their placement. Complications can present in an immediate or delayed fashion and vary based on type of central venous access. Significant morbidity and mortality can result from complications related to central venous access. These complications can cause a significant healthcare burden in cost, hospital days, and patient quality of life. Advances in imaging, access technique, and medical devices have reduced and altered the types of complications encountered in clinical practice; but most complications still center around vascular injury, infection, and misplacement. Recognition and management of central line complications is important when caring for patients with vascular access, but prevention is the ultimate goal. This article discusses common and rare complications associated with central venous access, as well as techniques to recognize, manage, and prevent complications.

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.