an uncommon complication of a common procedure

IMAGES IN SURGERY An Uncommon Complication of a Common Procedure Demetrios N. Moris & Adamantios Michalinos & Spiridon Vernadakis Received: 31 March 2014 /Accepted: 27 April 2014 # Association of Surgeons of India 2014 Abstract Constant, safe and reliable endovascular access is necessary for patients’ diagnosis and treatment. Endovascular access is possible with a variety of means, including central and peripheral venous catheters. Peripheral catheterization is an extremely common medical procedure and is considered risk-free or associated with minimal complications. Still potentially serious complications can occur. Authors describe a rare case of peripheral catheter migration at left pulmonary artery in an immunosuppressed patient. Keywords Catheter tip . Migration . Emboli . Peripheral venous Image A 61-year-old man became febrile on the 8th postoperative day following renal transplantation from a deceased donor, (T=37.3 °C). On clinical examination, he presented sensitivity and hardness at a 16 French Gauge peripheral venous catheter (PVC) insertion place in the right cephalic vein. The change was copious due to local inflammation, and catheter was extracted with a fraction of its tip. The tip was not traceable by palpation. The patient remained febrile (T=37.4 °C) but local hardness and pain subsided. Laboratory tests were unre- markable. Two days later, the patient had a routine chest X-ray after hemodialysis (Fig. 1 ). X-ray showed a linear radioopaque shadow of the left lung (Fig. 2), consistent with migration of catheter tip upward into a segmental branch of the left pulmonary artery. No further intervention was decided. Fever was attributed to urinary tract infection related to Foley catheter and was treated by antibiotics. At 1-month follow-up visit, the patient remains asymptomatic and normoxic. A variety of complications including the relatively common phlebitis, infections and extravasation of fluids and uncommon ones like migration are connected to venous Fig. 2 Magnification demonstrating the precise embolization site Fig. 1 Chest X-ray demonstrating peripheral venous catheter at left pulmonary artery D. N. Moris : A. Michalinos : S. Vernadakis Transplantation Unit, Laikon General Hospital, University of Athens, Athens, Greece A. Michalinos (*) 4th floor, Agiou Thoma 17 str., Goudi, Athens 11527, Greece e-mail: [email protected] Indian J Surg DOI 10.1007/s12262-014-1096-4

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IMAGES IN SURGERY

An Uncommon Complication of a Common Procedure

Demetrios N. Moris & Adamantios Michalinos &Spiridon Vernadakis

Received: 31 March 2014 /Accepted: 27 April 2014# Association of Surgeons of India 2014

Abstract Constant, safe and reliable endovascular access isnecessary for patients’ diagnosis and treatment. Endovascularaccess is possible with a variety of means, including centraland peripheral venous catheters. Peripheral catheterization isan extremely common medical procedure and is consideredrisk-free or associated with minimal complications. Still po-tentially serious complications can occur. Authors describe arare case of peripheral catheter migration at left pulmonaryartery in an immunosuppressed patient.

Keywords Catheter tip . Migration . Emboli . Peripheralvenous

Image

A 61-year-old man became febrile on the 8th postoperativeday following renal transplantation from a deceased donor,(T=37.3 °C). On clinical examination, he presented sensitivityand hardness at a 16 French Gauge peripheral venous catheter(PVC) insertion place in the right cephalic vein. The changewas copious due to local inflammation, and catheter wasextracted with a fraction of its tip. The tip was not traceableby palpation. The patient remained febrile (T=37.4 °C) butlocal hardness and pain subsided. Laboratory tests were unre-markable. Two days later, the patient had a routine chest X-rayafter hemodialysis (Fig. 1). X-ray showed a linearradioopaque shadow of the left lung (Fig. 2), consistent withmigration of catheter tip upward into a segmental branch of

the left pulmonary artery. No further intervention was decided.Fever was attributed to urinary tract infection related to Foleycatheter and was treated by antibiotics. At 1-month follow-upvisit, the patient remains asymptomatic and normoxic.

A variety of complications including the relatively com-mon phlebitis, infections and extravasation of fluids and un-common ones like migration are connected to venous

Fig. 2 Magnificationdemonstrating the preciseembolization site

Fig. 1 Chest X-ray demonstrating peripheral venous catheter at leftpulmonary artery

D. N. Moris :A. Michalinos : S. VernadakisTransplantationUnit, Laikon General Hospital, University of Athens,Athens, Greece

A. Michalinos (*)4th floor, Agiou Thoma 17 str., Goudi, Athens 11527, Greecee-mail: [email protected]

Indian J SurgDOI 10.1007/s12262-014-1096-4

Page 2: An Uncommon Complication of a Common Procedure

catheterization [1]. While complications in terms of severityand frequency are vigorously described in central venouscatheters [2], data are sparse other peripheral venous catheter.The risk of serious complications in catheter embolism isunknown. High-risk anatomic regions include the intracardiacarea, while risk is lower in the vena cava, and the lowest if theembolus is located in the pulmonary artery. Catheter embo-lism may remain undiagnosed for a prolonged period and canbe found incidentally. If conservative management is opted, asequential radiographic follow-up is essential even in asymp-tomatic patients to prevent potentially life threatening compli-cations in future from catheter further migration. In caseremoval is considered necessary based on symptoms or dete-rioration of blood gases, available methods include snares,

biopsy forceps, baskets, pigtail catheters and surgical inter-vention [3].

References

1. Singh S, Prakash J, Shukla VK, Singh LKS (2010) Intravenouscatheter associated complications. J Assoc Physicians India 58:194–196

2. Amerasekera SSH, Jones CM, Patel R, CleasbyMJ (2009) Imaging ofthe complications of peripherally inserted central venous catheters.Clin Radiol 64(8):832–840

3. Strohmer B, Altenberger J, Pichler M (2012) A new approach ofextracting embolized venous catheters using a large-diameter steerablesheath under biplane fluoroscopy. Clin Imaging 36(5):502–508

Indian J Surg

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