Percutaneous retrieval of fractured intravascular catheters in premature infants

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.

Percutaneous retrieval of intravascular foreign body in children: a case series and review

BACKGROUND

Percutaneous retrieval of intravascular foreign bodies has recently increased as a treatment option.

PURPOSE

To report our single-center experience of the percutaneous retrieval of 14 intravascular embolized catheter fragments in children and to conduct a literature review.

MATERIAL AND METHODS

MEDLINE databases were searched for case reports and series including children and iatrogenic catheter fragments or guidewires retrieved through percutaneous techniques. We also conducted a retrospective analysis of 14 cases from our institution over a 14-year period. A total of 27 studies were selected comprising 74 children, plus our 14 unpublished cases. Statistical analyses were performed using Microsoft Excel version 2016.

RESULTS

Port catheter fragments and peripherally inserted central catheters (PICCs) were the most embolized foreign bodies and the pulmonary artery was the most common site of embolization in 44.1% of cases. Analysis of the retrieval technique demonstrated a preference for extraction through the femoral vein (81.7%) and using snare techniques (93.5%). The success rate of percutaneous retrieval was 96.6% with only 1.1% of procedure-related complications. Patients were asymptomatic in 77.2% of cases, presented septic complications in 2.3%, and no deaths were reported. Median fluoroscopy time was 10 min (range = 1.7-80 min) and median procedure length was 60 min (range = 35-208 min).

CONCLUSION

Percutaneous retrieval of intravascular foreign bodies is a feasible, safe, and efficient technique in children and should be considered the preferred treatment option.

Retrieval of an Intracardiac Cannula Fragment via Femoral Access in a Premature Infant

A preterm infant with birth weight 1,550 g had an intravenous foreign body between the external iliac vein and the common iliac vein, which accidentally happened during peripheral intravascular central catheter insertion by the Seldinger technique. The infant initially received conservative management and close monitoring. Antibiotics were administered 4 weeks to treat culture positive sepsis and meningitis. The infant was clinically stable till the cannula fragment migrated to the heart 34 days later. At that time, his weight was 2,200 g, and he was full fed. The cannula fragment was retrieved by emergency interventional radiology via the right femoral access, with no complications. The infant was discharged at 45 days of age and closely followed up post-discharge. He is currently 6 months old, with normal development. This is the first case of successful percutaneous retrieval of an intracardiac intravenous cannula fragment via femoral access in a premature infant in China.