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Retrieval of fragmented peripherally inserted central catheter (PICC) with a double transfemoral access technique

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Clinical Case Reports
Authors:
Alfonso Papa at AORN Ospedali dei Colli
Alfonso Papa
Dario Tammaro at AORN Ospedali dei Colli
Dario Tammaro
Vittorio Monda at Monaldi Hospital
Vittorio Monda
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Abstract and Figures

Retrieval of central venous catheters fragments often puts us in front of different situations. Having more techniques available for strategic planning of the procedure is important. The authors propose the simultaneous use of two different approaches for the recovery of a CVC fragment from the pulmonary artery.
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Clin Case Rep. 2020;8:3660–3661.
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CASE DESCRIPTION
Retrieval of central venous catheter fragments often puts
us in front of different situations. Having more techniques
available for strategic planning of the procedure is important.
The authors propose the simultaneous use of two different
approaches for the recovery of a CVC fragment from the pul-
monary artery.
For vascular catheter fragment recovery, there are several
techniques including use of pigtail catheter or gooseneck
snare.1,2 We describe the case of a PICC fragment migrated
into lower branch of right pulmonary artery Figure1Retrieval
using a pigtail catheter and a gooseneck snare inserted at the
same time with a double transfemoral access. The pigtail
catheter was used to withdraw the catheter from the pulmo-
nary artery, while at the same time, the gooseneck snare was
used to grasp the end of fractured catheter to prevent blood
flow from returning the fragment to the pulmonary artery
Video S1.
Received: 7 June 2020
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Accepted: 1 July 2020
DOI: 10.1002/ccr3.3189
CLINICAL VIDEO
Retrieval of fragmented peripherally inserted central catheter
(PICC) with a double transfemoral access technique
AlfonsoPapa1,2
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DarioTammaro2
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VittorioMonda3
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original
work is properly cited.
© 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd
1Pain Department, AO Ospedali dei Colli
Monaldi Hospital, Napoli, Italy
2CVC Team, AO Ospedali dei Colli
Monaldi Hospital, Napoli, Italy
3Division of Cardiology, AO Ospedali dei
Colli Monaldi Hospital, Napoli, Italy
Correspondence
Alfonso Papa, AO Ospedali dei Colli
Monaldi Hospital, via Leonardo Bianchi,
1 – 80131 - Napoli, Italy.
Email: alfonsopapa@libero.it
Abstract
Retrieval of central venous catheters fragments often puts us in front of different situ-
ations. Having more techniques available for strategic planning of the procedure is
important. The authors propose the simultaneous use of two different approaches for
the recovery of a CVC fragment from the pulmonary artery.
KEYWORDS
CVC fragment, peripherally inserted central catheter, retrieval CVC
FIGURE 1 Fragmented PICC migrated into lower branch of right
pulmonary artery (arrow) and medially positioned loop (star)
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PAPA et Al.
ACKNOWLEDGMENTS
The authors would like to acknowledge the patient for pro-
viding consent to share her case.
CONFLICTS OF INTEREST
The authors state that they have no conflicts of interest. This
research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
AUTHOR CONTRIBUTIONS
AP: involved in conception and drafting of the article and
video storing. DT and VM: performed technique and acquire
images.
ETHICAL STATEMENT
This study was in accordance with the 1964 Helsinki
Declaration and its later amendments or comparable ethical
standards.
ORCID
Alfonso Papa https://orcid.org/0000-0003-4489-714X
REFERENCES
1. Li Y, Chen J, Li Z, et al. Successful percutaneous transvenous re-
trieval of intravascular fractured port catheter: a single center expe-
rience. J Cardiothorac Surg. 2020;15:101.
2. Peng J, Zhang XM, Yang L, et al. A novel two-step technique for
retrieving fractured peripherally inserted central catheter segments
migrating into the heart or the pulmonary artery[J]. Biomed Res Int.
2016;2016: 1-5.
SUPPORTING INFORMATION
Additional supporting information may be found online in
the Supporting Information section.
How to cite this article: Papa A, Tammaro D,
Monda V. Retrieval of fragmented peripherally
inserted central catheter (PICC) with a double
transfemoral access technique. Clin Case Rep.
2020;8:3660–3661. https://doi.org/10.1002/ccr3.3189
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Supplementary resource (1)

Video: Retrieval of fragmented peripherally inserted central catheter (PICC) with a double transfemoral access technique
Data
August 2020
Alfonso Papa · Dario Tammaro · Vittorio Monda
ResearchGate has not been able to resolve any citations for this publication.
Successful percutaneous transvenous retrieval of intravascular fractured port catheter: a single center experience
Article
Full-text available
  • May 2020
  • J CARDIOTHORAC SURG
Background: Fractured catheter as a foreign body in situ is a rare complication after port catheter placement. We report a single center's experience on percutaneous transvenous retrieval of intravascular fractured port catheter and treatment techniques. Methods: Patients undergoing percutaneous transvenous retrieval of intravascular fractured port catheter from Jan 2010 to Dec 2018 were retrospectively collected. A total of 10 patients (8 females and 2 males) were enrolled in this study. Procedures were performed within 1 day after diagnosis. Two methods of retrieval were considered, direct retrieval by gooseneck snare and guide wire as media to retrieve were used in the procedure. Results: All the fractured catheters in 10 patients were successfully retrieval by 2 methods, direct retrieval by gooseneck snare(n = 6) and guide wire as media of retrieval(n = 4). The time interval between port catheter implantation and discovery of catheter fracture was 36.50 ± 42.99(ranged 1 to 146) days. The operation time was 24.10 ± 8.32(ranged 10 to 36) minutes. No immediate procedure related or 1 month follow-up complications occurred in all the 10 patients. Conclusion: Percutaneous transvenous retrieval of intravascular fractured port catheter is a simple and safe procedure, which maybe recommended as the first choice for patients with fractured port catheter in situ.
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A Novel Two-Step Technique for Retrieving Fractured Peripherally Inserted Central Catheter Segments Migrating into the Heart or the Pulmonary Artery
Article
Full-text available
Objective. To report the experience of a percutaneous technique for retrieving fractured peripherally inserted central catheter (PICC) segments migrating into the heart or the pulmonary artery. Method. From April 2013 to July 2015, we performed percutaneous retrieval of fractured PICC segments migrating into the heart or the pulmonary artery in five cancer patients who had undergone chemotherapy via PICC. The fractures were diagnosed with chest plain radiography. The patients included three cases of breast cancer, one case of rectal cancer, and one case of lower limb Ewing’s tumor. The fractures were retained in the vessels of the patients for 1 to 3 days. All the fractures were retrieved by using a novel two-step technique in the digital subtraction angiography (DSA) suite. This two-step technique involves inserting a pigtail catheter to the heart or the pulmonary artery to grasp the fractured catheter fragment and bring it to the lower segment of the inferior vena cava, followed by grasping and removing the catheter fragment with a retrieval loop system of the vena cava filter retrieval set. Result. The fractured PICC segments were removed successfully in all five patients via unilateral (four patients) or bilateral (one patient) femoral vein access. No complications occurred during the interventional procedure. Conclusion. Percutaneous retrieval can be a safe, convenient, and minimally invasive method for the removal of fractured PICC segments. The technique reported in this paper will be applicable for the retrieval of fractured PICC segments and other catheter fragments migrating into the heart or the pulmonary artery.
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