Difficult removal of implantable venous access system: stepladder approach with wire stenting of a catheter—single-center experience
Tóm tắt
Port-a-catheter insertion and removal are common procedures performed for children with chronic disease or cancer. Although its removal is usually straightforward, some difficulties during the procedure can be encountered. Several methods have been described in the literature to handle those cases where lines have become stuck. To describe our simple technique in dealing with stuck port-a-catheters during removal. We will additionally report the incidence and factors associated with this complication. A retrospective chart review study was performed between January 2009 and December 2019. Of a collective 2040 ports that were removed during the research interval, cases of difficult port removal were collected and reviewed. In 42 cases, catheter removal difficulty is encountered, and a second incision at the venous access site is performed. Failure of this procedure in removing the stuck catheter is then followed by catheter stenting and removal over a guide wire. Difficult removal of port-a-catheters was experienced in 42 cases (2%). The mean age at removal for those cases was 6.6 years. Most of the port-a-cath removals were done after treatment completion (74%). Ports had been left in situ for a mean duration of 44 months. The stepladder technique with wire stenting of the catheter was successful in 37 cases (88%), while the rest were only partially removed (distal part). The retained part was extracted using an angiographic technique. No short- or long-term complications were encountered in any of those 42 patients. Stepladder with wire stenting of catheters approach deals with difficult line removals. Our technique is, therefore, simple, feasible, and effective. IV.
Tài liệu tham khảo
Wilson GJP, van Noesel MM, Hop WCJ, van de Ven C. The catheter is stuck: complications experienced during removal of a totally implantable venous access device. A single-center. 2006.
Wall JL, Kierstead VL. Peripherally inserted central catheters: resistance to removal: a rare complication. J IntravenNurs. 1995;18(5):251–4.
Bawazir O. Management of stuck long. 2018. https://doi.org/10.24327/ijcar.2018.15678.2870.
Bautista F, Gomez-Chacon J, Costa E, et al. Retained intravascular fragments after removal of indwelling central venous catheters: a single institution experience. J Pediatr Surg. 2010;45:1491–5. https://doi.org/10.1016/j.jpedsurg.2010.02.001.
Aworanti O, Linnane N, Tareen F, Mortell A. Incidence and outcome of retained port-a-cath fragments during removal. Pediatr Surg Int. 2017;33(7):777-781. https://doi.org/10.1007/s00383-017-4103-6.
Xiang DZ, Verbeken EK, Van Lommel ETL, Stas M, De Wever I. Composition and formation of the sleeve enveloping a central venous catheter. J Vasc Surg. 1998;28:260–71.
Forauer AR, Theoharis C. Histological changes in the human vein wall adjacent to indwelling central venous catheters. J Vasc Intervent Radiol. 2003;14:1163–8.
Chan BKY, Rupasinghe SN, Hennessey I, et al. Retained central venous lines (CVLs) after attempted removal: an 11-year series and literature review. J Pediatr Surg. 2013;48:1887–91. https://doi.org/10.1016/j.jpedsurg.2013.01.050.
Andris DA, Krzywda EA, Schulte W, Ausman R, Quebbeman EJ. Pinch-off syndrome: a rare etiology for central venous catheter occlusion. JPEN J Parenter Enteral Nutr. 1994;18(6):531–3. https://doi.org/10.1177/0148607194018006531. PMID: 7602729.
Nakabayashi K, Nomura H, Isomura D, Sugiura R, Oka T. Successful retrieval of a dismembered central venous catheter stuck to the right pulmonary artery using a stepwise approach. Case Rep Cardiol. 2016;2016:6294263.
Lee D, Shaffer K. Wandering catheter through pulmonary vasculature. Radiology Case Reports. 2006;1:41.
Hong JH. A breakthrough technique for the removal of a hemodialysis catheter stuck in the central vein: endoluminal balloon dilatation of the stuck catheter. J Vasc Access. 2011;12(4):381–4.
Huang S-C, Tsai M-S, Lai H-S. A new technique to remove a ‘stuck’ totally implantable venous access catheter. J Pediatr Surg. 2009;44(7):1465–7.
Chen P-C, Chen C-J. Removal of retained port-a catheter in central lines in a pediatric population. Tzu Chi Med J. 2007;19(4):245–8.
Milbrandt K, Beaudry P, Anderson R, et al. A multi-institutional review of central venous line complications: retained intravascular fragments. J Pediatric Surg. 2009;44:972–6.
Peng CH, Tan PH, Chou AK, et al. Retention of broken central venous catheters in the pulmonary artery and inferior vena cava – a case report. Acta Anaesthesiol Sin. 1997;35(3):171–4.
Jones SA, Giacomantonio M. A complication associated with central line removal in the pediatric population: retained fixed catheter fragments. J Pediatric Surg. 2003;38:594–6.
Espiritu JD, Stolar CG. Pulmonary hypertension due to a retained totally implantable venous access device fragment. Chest. 2007;131:1574–6.