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... single-lumen 18-guage (4 Fr) catheter (Bard Groshong, USA) was inserted via the basilic vein of the left arm at the point of 0.5 cm below elbow crease on December 22, 2010. Postoperative routing chest radio- graph showed the tip position of the line was at the beginning of the superior vena cava (SVC) with 37 cm long inserted (Figure 1). Blood withdraw and infusion though the catheter all did well. ...
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... The accurate incidence rate of PICC fractures still needs to be discovered due to a lack of long-term data and large prospective studies. Chow [16,17]. Catheter fatigue was also hypothesized as the probable reason for fracture in our case. ...
The peripherally inserted central catheter (PICC) is a non-tunneled central venous catheter placed in the upper limb venous system, mainly in the basilic vein, and the tip terminates in the superior vena cava (SVC). A PICC is a preferred modality of central venous access in oncology, as it is associated with minimal discomfort and can be kept in situ for up to one year. Despite multiple advantages, it is also associated with complications. Fracture and migration are rare but potentially serious complications that can lead to arrhythmias, cardiac perforation, cardiac tamponade, pulmonary embolism, and sepsis. The migrated PICC fragment can be retrieved using percutaneous techniques, which have a high success rate of excess, with minimum complications. In our patient of adenocarcinoma gastroesophageal junction, the fractured and migrated PICC to pulmonary arteries was retrieved using the balloon catheter method. With more and more cancer patients using PICCs for chemotherapy administration, healthcare workers must be aware of the standard and sporadic complications of PICCs. Care of the PICC is crucial, and any lapse may lead to fracture and embolization, which is a potentially life-threatening complication. This case highlights the importance of healthcare persons being aware of the possibility of catheter embolization and methods to prevent and mitigate this phenomenon.
... Central catheters are used in situations requiring prolonged intravenous access such as parenteral nutrition, antibiotic infusion, chemotherapy infusion, hemodialysis, or infusion of drugs known to cause phlebitis when infused directly into peripheral veins [5,6]. Hemorrhage at the insertion site, pneumothorax, pneumohemothorax, and venous thrombosis are some of the frequent adverse events encountered from central catheter use [4]. ...
... Central catheter fractures can result from a multitude of situations including shearing of the catheter during insertion due to contact with the introducer needle, increased intracatheter pressure often due to bolus infusion, patient body movement resulting in fracture of the external portion of the line seen specially in infants, mechanical forces between the first rib and clavicle, and catheter fatigue due to prolonged exposure to motion of the tricuspid valve and/or right ventricle [10]. A fractured catheter can result in pulmonary embolism, cardiac arrhythmia, myocardial ischemia, valvular perforation, abscess formation, septicemia, cardiac arrest, or even sudden death and will often present with symptoms associated with those conditions [2,5]. ...
A 22-year-old male admitted with multiple gunshot wounds (GSW) had central line placed initially for hemodynamic monitoring and later for long term antibiotics and total parenteral nutrition (TPN). On postoperative day 4 he presented with bouts of nonsustained ventricular tachycardia; the cause was unknown initially and later attributed to a catheter fragment accidentally severed and lodged in the right heart. Percutaneous retrieval technique was used to successfully extract the catheter fragment and complete recovery was achieved.
Peripherally inserted central catheter (PICCs) are popular means of long-term intravenous access in oncology patients. Fracture and embolization are rare but potentially serious complications. Here we present an unusual fracture of the PICC line in a 9-year-old boy with Ewing's sarcoma with embolization to the right ventricle (RV) and right pulmonary artery (RPA) which was retrieved percutaneously by trans-catheter snare assisted retrieval. Adequate care and precautions like handling by trained nursing staff/parental education must be undertaken to prevent such complications.
Peripherally inserted central catheters (PICCs) are a feasible alternative to conventional central venous access. PICCs are often used perioperatively for central venous pressure monitoring and administration of vasoactive drugs especially in cancer patients. Catheter breakage and embolization are rare but potentially fatal complications, and most of the reported literature pertains to pediatric patients after medium- to long-term use. In this report, we describe a rare scenario of catheter breakage, entrapment, and embolization in a patient caused by inadvertent surgical clip and suture placement.
