RETRIEVAL OF BROKEN CATHETER FROM RIGHT HEART VENTRICULAR.

With the rapid advancement and broad range of applications of invasive cardiovascular procedures, the rate of complications from such techniques including intravascular foreign bodies are on the rise. These complications can lead to various other adverse outcomes, such as thrombus formation, migration of the foreign body to other vital organs, cardiac arrhythmia and infections. Removal of such objects is performed by either surgery or interventional techniques, with the latter being preferred.

The patient was a 60-year old woman presented with dyspnea, nausea and hemorrhage from a permanent jugular catheter that had been used for hemodialysis, because her AV fistula has been mal-functioning. Her past medical history included chronic renal failure.

As part of the work up, a blood culture was performed that turned positive for coagulase positive staphylococcus aureus. This led to decision to remove the jugular catheter. During the procedure, the catheter was broken and a long segment of it was embolized through the superior vena cava to the heart. Patient is transferred to the angiography unit. The two ends of a 0-014” guide wire are passed through the two orifices of an NIH catheter. By passing the two ends of the guide wire at the tip of the NIH catheter an adjustable loop is formed that can trap the foreign body. Using a pigtail catheter, the broken piece is pulled into the IVC. The NIH catheter was then used to successfully pull the object out of the femoral vein.

A literature survey revealed that the incidence of catheter fracture is about 0% to 2.1%. Emboilization of fractured catheter maybe fatal. The chosen technique to remove fractured particle is a catheter based method (interventional).

A commercially available device, called snare, can be used to retrieve the fractured catheter. Since the conventional snare was not available, a similar device was built using NIH catheter and guide wire. In cases with high risk of complication in snaring of fractured catheter, the loose particle should be repositioned by a pigtail and then retrieved by snare.