Chest
Volume 117, Issue 4, April 2000, Pages 1209-1211
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Selected Reports
Retrieval of an IV Catheter Fragment From the Pulmonary Artery 11 Years After Embolization

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The use of a peripherally inserted central catheter (PICC) is occasionally complicated by intravascular fracture and central embolization of the catheter fragment. We present a patient in whom a PICC fragment was retrieved from the pulmonary artery 11 years after embolization following its incidental detection. Despite a history of IV drug abuse and mitral regurgitation, this patient remained asymptomatic and without complications. The catheter fragment was retrieved since the patient was believed to be at risk for endocarditis. This may be the longest duration reported of an embolized catheter fragment that was successfully removed. As the natural history of asymptomatic-retained central venous foreign bodies remains unclear, the decision to remove them should be individualized. In selected cases, these foreign bodies may be retrieved without complications even several years after embolization.

Section snippets

Case Report

A 40-year-old woman was hospitalized for IV antibiotic treatment of right foot cellulitis. A PICC was placed through the right antecubital vein for this purpose. Chest radiograph confirmed the PICC position with its tip terminating in the superior vena cava. Also noted on the chest radiograph was a catheter fragment in the left pulmonary artery that had no continuity with the PICC positioned in the superior vena cava (Fig 1). The PICC was immediately removed, inspected, and found to be intact

Discussion

Inadvertent fracture and fragment embolization of indwelling venous catheters continues to occur despite the use of meticulous techniques. Catheter fatigue from prolonged use contributes to in situ fracture, fragmentation, and distal embolization.1 The catheter fragments migrate distally along the blood stream finally lodging in the vena cava, right atrium, right ventricle, or the main pulmonary artery or one of its branches. The final site of lodgment depends on their length, weight, and the

Conclusion

Centrally embolized foreign bodies may be associated with serious complications. The true rate of complication is unknown due to the lack of long-term follow-up data. In selected cases, it may be possible to retrieve these foreign bodies at a low risk even several years after embolization. The decision to extract such foreign bodies should be individualized based on their location and the risk of possible complications.

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