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Case Report

Case Report: Using ultrasound to prevent a broken catheter from migrating to the heart.

[version 1; peer review: 2 approved]
PUBLISHED 03 May 2017
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Abstract

Peripheral intravenous (IV) catheters can break off while still in the patient, with possible detrimental effects such as upstream migration to the heart. These catheters have probably been damaged by the needle during a difficult insertion. A peripheral IV catheter was removed in a 90 year old patient and only half of the catheter was retrieved. By using ultrasound examination the remaining part of the IV catheter was identified, and retrieved surgically, before it could migrate towards the heart. This case report suggests that ultrasound should not only be used for difficult placement of a peripheral IV catheter, but can also be used when removal is complicated.

Keywords

broken catheter, ultrasound, echography,

Introduction

Peripheral intravenous (IV) catheters are given every day to many patients, without much attention given to possible complications. The complications are usually minor, for instance phlebitis or subcutaneous injection of solutions. However, when placement is difficult and the needle of the IV catheter is reinserted for another attempt, the needle can cut the catheter and damage it in such a way that it might break while inside the vein. These fragments can migrate to the right side of the heart, both atrium and ventricle, evidenced by reports in the literature1,2.

Case report

We present the case of a 90 year old caucasian patient where only half of the peripheral IV catheter was retrieved after removal. By using ultrasound the remaining part of the catheter was identified and removed.

The patient was admitted to the hospital with a contained ruptured aneurysm of the abdominal aorta. The patient underwent emergency surgery and an aortic bifurcation prosthesis was placed. According to the anaesthesiologist who cared for the patient, the peripheral catheter was used to administer the anaesthetics and induction of anaesthesia went as planned. After induction, a central venous catheter was placed and the peripheral catheter was no longer used. Post operatively the patient was admitted to the intensive care unit (ICU) where the peripheral catheter was removed and only the proximal half of the catheter came out. We examined the arm but could not palpate the remaining part of the catheter. Ultrasound examination, performed by the ICU resident, showed an echogenic hollow tube (Figure 1), eight centimeters proximal of the insertion site of the catheter. The surgeon made a small incision and the remaining part of the catheter was removed (Figure 2). We were not able to trace the person who placed the IV catheter, to evaluate the technique used.

012d77b1-e845-4979-881c-cb5803d87a76_figure1.gif

Figure 1. Ultrasound image of the lower arm.

The black arrow indicates the broken catheter.

012d77b1-e845-4979-881c-cb5803d87a76_figure2.gif

Figure 2. Broken distal part of the peripheral catheter after retrieval.

Discussion

This case describes the succesful use of ultrasound as a diagnostic tool for difficulties encountered after peripheral IV catheter removal.

We hypothesize that the needle was reinserted in the catheter during placement because placement was difficult. By doing so, the needle may have cut the distal part of the catheter. Reinserting a needle back into a catheter can be dangerous, and there is a risk of damaging the catheter or cutting it off and thereby allowing the free part of the catheter to migrate to the heart, a consequence that could be disastrous and would make removal of the catheter far more difficult3,4. The use of ultrasound made a quick diagnosis and enhanced treatment possible, thereby preventing further complications.

Consent

Written informed consent for publication of clinical details and clinical images was obtained from the patient.

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how to cite this article
Schraverus PJ, van Rijswijk S and Tuinman PR. Case Report: Using ultrasound to prevent a broken catheter from migrating to the heart. [version 1; peer review: 2 approved]. F1000Research 2017, 6:616 (https://doi.org/10.12688/f1000research.11206.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 03 May 2017
Views
24
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Reviewer Report 06 Jul 2017
Joris Lemson, Department of Intensive Care, Radboud University Medical Centre, Nijmegen, The Netherlands 
Approved
VIEWS 24
This case report shows the usefulness of ultrasound when a broken intravenous canula had migrated away from the insertion location. The case is adequately described and illustrated and the message is clear. It would be of interest to know if ultrasound devices that ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Lemson J. Reviewer Report For: Case Report: Using ultrasound to prevent a broken catheter from migrating to the heart. [version 1; peer review: 2 approved]. F1000Research 2017, 6:616 (https://doi.org/10.5256/f1000research.12090.r22448)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Views
29
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Reviewer Report 08 May 2017
Michiel Justinus Blans, Department of Internal Medicine and Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands 
Approved
VIEWS 29
This case report shows that ultrasound can also be used for the described indication. It is well structured and the photo material is clearly showing the described content. Being a short case report no literature review is needed. It is ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Blans MJ. Reviewer Report For: Case Report: Using ultrasound to prevent a broken catheter from migrating to the heart. [version 1; peer review: 2 approved]. F1000Research 2017, 6:616 (https://doi.org/10.5256/f1000research.12090.r22447)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 03 May 2017
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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