Technical Notes
735
TECHNICAL NOTES
Vol. 116
more superficial than they are. Some practice is required to develop a new sense of depth perception to puncture these veins. This, however, is possible in a short time and has been taught to both radiology residents and to x-ray technologists. Our experience in over 40 cases indicates that venipuncture in infants is simplified with the use of transillumination, and far fewer attempts are now required for successful intravenous studies in infants and obese children. ADDENDUM: Since submission of this technical note, we have learned that this technique has been previously described (1) using a different high-intensity transilluminator, the " Mini-Light Portable Illuminator" (2). This other, more expensive illuminator has a flexible, semi-rigid fiberoptic probe which can be placed on the extremity and
maintains its own position there, eliminating the need for an extra assistant to hold the transilluminator during venipuncture.
•
of the catheter fragment from the right heart with a basket or a loop wire. The basket was replaced with a curved French 7 green Kifa catheter, one that is commonly used for selective arteriography. The embolized catheter was hooked with the Kifa catheter but attempts to extract it into the vena cava were unsuccessful. The catheter hook repeatedly "opened" and would slip off the rather firmly fixed embolized fragment. This occurred despite use of the maneuvers described by Maxwell and Anderson (1). A Cook tip deflecting wire was then inserted into the catheter. Initially this decreased the diameter of the curve to some degree. As the system was withdrawn, the catheter and wire would "hang" in the region of the hepatic vein orifices (Fig. 2, A). The wire was withdrawn approximately 2 cm from the tip of the catheter and the curve in the catheter assumed an oval shape (Fig. 2, B). The embolized catheter fragment was then easily withdrawn into the inferior vena cava. A Curry intravascular retriever (loop wire) (8) was introduced percutaneously into the left femoral vein. The embolized catheter was successfully snared in the inferior vena cava and easily withdrawn through the puncture site in the left femoral vein.
•
Extraction of an Embolized Central Venous Catheter Using Percutaneous Technique 1 Richard G. Fisher, M.D. and John R. Romero, M.D.
A method of intracardiac catheter fragment retrieval using a hook-shaped catheter and wire loop snare is described. A venous cutdown was not necessary for removal of the foreign body. Angiography, complications. Catheters and catheterization, complications • Heart, foreign bodies
INDEX TERMS:
Radiology 116:735-736, September 1975
•
•
Thirty-one cases of retrieval of intravascular catheter and guide wire fragments have been reported in the radiologic literature (1-8). A variety of techniques have been used, including loop snares, wire baskets, bronchoscopic forceps. Loop snares seem to be the most successful. In addition, there have been four cases in which a "hook catheter" technique was used (1,3,5). This report describes the combined use of a hook catheter and loop snare. Difficulties encountered in using the hook catheter are described, and the method for percutaneous extraction of the fragment is emphasized.
REFERENCES 1. Gerbitz S: Transillumination helps nurses find veins. Nursing 74:12, Oct 1974 2. Available from Med General, 7851 Metro Parkway, Minneapolis, Minn. 1 From the Division of Pediatric Radiology, Department of Radiology, C. S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, Mich. 48104. Accepted for publication in April 1975. 2 Available from Radiation Measurements, Inc., P.O. Box 44, Middleton, Wis. 53562. dk
DISCUSSION The removal of the embolized catheter in this patient employed several of the methods described in the literature (1, 5,
CASE REPORT A 22-year-Old man was admitted to Ben Taub General Hospital on March 11, 1974, with third degree burns of the face, neck, chest, and arms sustained in a gasoline explosion accident. Prolonged hospitalization and extensive care involving fluid, electrolyte maintenance, and multiple surgical procedures including debridement and skin grafting were ultimately required. On March 14, 1974, three days following admission, a central venous pressure catheter was inadvertently severed in the right subclavian vein. An anteroposterior chest radiograph revealed a segment of polyethylene tubing embolized to the heart. After consultation, the patient was brought to the special procedures section of the Radiology Department. Under local anesthesia, a Dotter intravascular retriever set (wire basket) (4) was inserted percutaneously into the right femoral vein. Attempts to remove the catheter were unsuccessful. Further inspection of the chest radiograph revealed that the catheter extended from the right subclavian vein into the main pulmonary artery (Fig. 1). This prevented retrieval
" Fig. 1. Diagram of the embolized catheter which extended from the right subclavian vein to the main pulmonary artery.
736
TECHNICAL NOTES
September 1975
removed an embolized catheter fragment with a hook catheter and no deflector system. It would be reasonable to say that no single system will be successful in all cases, and some degree of ingenuity is helpful. A venotomy has been required in the extraction of the embolized catheter fragments in the majority of the previously reported cases (1, 3, 4, 5, 7, 8). Percutaneous removal has been accomplished in three cases previously (2, 6). Initially our intention was to remove the fragment through a Teflon sheath as described by Randall (2), but the sheath became jammed on the catheter and the embolized fragment was pulled out through the venotomy puncture site in a method similar to that described by Miller et al. (6). The diameter of the embolized catheter folded upon itself was equivalent to or slightly less than the diameter of the Teflon catheter used to extract it. It was easily withdrawn through the puncture site and there were no sequelae. REFERENCES
Fig. 2. A. The "open" appearance of the catheter and wire deflector system is seen as they "hang" on what is thought to be the left hepatic vein. Arrow indicates the embolized catheter. B. The oval configuration of the catheter was achieved by withdrawing the deflector wire approximately 2 em from the tip of the catheter. The larger arrow indicates the tip of the deflector wire.
1. Maxwell DO, Anderson RE: TransfemoraI retrieval of an intracardiac catheter fragment, using a simple hook-shaped catheter. Radiology 103:213-214, Apr 1972 2. Randall PA: Percutaneous removal of iatrogenic intracardiac foreign body. Radiology 102:591-595, Mar 1972 3. McSweeney WJ, Schwartz DC: Retrieval of a catheter foreign body from the right heart using a guide wire deflector system. Radiology 100:61-62, Jul 1971 4. Dotter CT, Rosch J, Bilbao MK: Transluminal extraction of catheter and guide fragments from the heart and great vessels: 29 collected cases. Am J RoentgenoI11:467-472, Mar 1971 5. Rossi P: "Hook catheter," technique for transfernoral removal of foreign body from right side of the heart. Am J Roentgenol 109:101-106, May 1970 6. Miller RE, Cockerill EM, Helbig H: Percutaneous removal of catheter emboli from the pulmonary arteries. Radiology 94:151-153, Jan 1970 7. Henley FT, Ballard JW: Percutaneous removal of flexible foreign body from the heart. Radiology 92:176, Jan 1969 8. Curry JL: Recovery of detached intravascular catheter or guide wire fragments: a proposed method. Am J Roentgenol 105: 894-896, Apr 1969
8). Contrary to the experience of Maxwell and Anderson (1), it was necessary to use the guide wire from a Cook deflector system as described by Rossi (5). Maxwell had successfully
, From the Department of Radiology (R. G. F., Assistant Professor, Director of Special Procedures; J. R. R., second-year radiology resident), Baylor College of Medicine, Texas Medical Center, Houston, Texas 77025. Accepted for publication in April 1975. dk
735
TECHNICAL NOTES
Vol. 116
more superficial than they are. Some practice is required to develop a new sense of depth perception to puncture these veins. This, however, is possible in a short time and has been taught to both radiology residents and to x-ray technologists. Our experience in over 40 cases indicates that venipuncture in infants is simplified with the use of transillumination, and far fewer attempts are now required for successful intravenous studies in infants and obese children. ADDENDUM: Since submission of this technical note, we have learned that this technique has been previously described (1) using a different high-intensity transilluminator, the " Mini-Light Portable Illuminator" (2). This other, more expensive illuminator has a flexible, semi-rigid fiberoptic probe which can be placed on the extremity and
maintains its own position there, eliminating the need for an extra assistant to hold the transilluminator during venipuncture.
•
of the catheter fragment from the right heart with a basket or a loop wire. The basket was replaced with a curved French 7 green Kifa catheter, one that is commonly used for selective arteriography. The embolized catheter was hooked with the Kifa catheter but attempts to extract it into the vena cava were unsuccessful. The catheter hook repeatedly "opened" and would slip off the rather firmly fixed embolized fragment. This occurred despite use of the maneuvers described by Maxwell and Anderson (1). A Cook tip deflecting wire was then inserted into the catheter. Initially this decreased the diameter of the curve to some degree. As the system was withdrawn, the catheter and wire would "hang" in the region of the hepatic vein orifices (Fig. 2, A). The wire was withdrawn approximately 2 cm from the tip of the catheter and the curve in the catheter assumed an oval shape (Fig. 2, B). The embolized catheter fragment was then easily withdrawn into the inferior vena cava. A Curry intravascular retriever (loop wire) (8) was introduced percutaneously into the left femoral vein. The embolized catheter was successfully snared in the inferior vena cava and easily withdrawn through the puncture site in the left femoral vein.
•
Extraction of an Embolized Central Venous Catheter Using Percutaneous Technique 1 Richard G. Fisher, M.D. and John R. Romero, M.D.
A method of intracardiac catheter fragment retrieval using a hook-shaped catheter and wire loop snare is described. A venous cutdown was not necessary for removal of the foreign body. Angiography, complications. Catheters and catheterization, complications • Heart, foreign bodies
INDEX TERMS:
Radiology 116:735-736, September 1975
•
•
Thirty-one cases of retrieval of intravascular catheter and guide wire fragments have been reported in the radiologic literature (1-8). A variety of techniques have been used, including loop snares, wire baskets, bronchoscopic forceps. Loop snares seem to be the most successful. In addition, there have been four cases in which a "hook catheter" technique was used (1,3,5). This report describes the combined use of a hook catheter and loop snare. Difficulties encountered in using the hook catheter are described, and the method for percutaneous extraction of the fragment is emphasized.
REFERENCES 1. Gerbitz S: Transillumination helps nurses find veins. Nursing 74:12, Oct 1974 2. Available from Med General, 7851 Metro Parkway, Minneapolis, Minn. 1 From the Division of Pediatric Radiology, Department of Radiology, C. S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, Mich. 48104. Accepted for publication in April 1975. 2 Available from Radiation Measurements, Inc., P.O. Box 44, Middleton, Wis. 53562. dk
DISCUSSION The removal of the embolized catheter in this patient employed several of the methods described in the literature (1, 5,
CASE REPORT A 22-year-Old man was admitted to Ben Taub General Hospital on March 11, 1974, with third degree burns of the face, neck, chest, and arms sustained in a gasoline explosion accident. Prolonged hospitalization and extensive care involving fluid, electrolyte maintenance, and multiple surgical procedures including debridement and skin grafting were ultimately required. On March 14, 1974, three days following admission, a central venous pressure catheter was inadvertently severed in the right subclavian vein. An anteroposterior chest radiograph revealed a segment of polyethylene tubing embolized to the heart. After consultation, the patient was brought to the special procedures section of the Radiology Department. Under local anesthesia, a Dotter intravascular retriever set (wire basket) (4) was inserted percutaneously into the right femoral vein. Attempts to remove the catheter were unsuccessful. Further inspection of the chest radiograph revealed that the catheter extended from the right subclavian vein into the main pulmonary artery (Fig. 1). This prevented retrieval
" Fig. 1. Diagram of the embolized catheter which extended from the right subclavian vein to the main pulmonary artery.
736
TECHNICAL NOTES
September 1975
removed an embolized catheter fragment with a hook catheter and no deflector system. It would be reasonable to say that no single system will be successful in all cases, and some degree of ingenuity is helpful. A venotomy has been required in the extraction of the embolized catheter fragments in the majority of the previously reported cases (1, 3, 4, 5, 7, 8). Percutaneous removal has been accomplished in three cases previously (2, 6). Initially our intention was to remove the fragment through a Teflon sheath as described by Randall (2), but the sheath became jammed on the catheter and the embolized fragment was pulled out through the venotomy puncture site in a method similar to that described by Miller et al. (6). The diameter of the embolized catheter folded upon itself was equivalent to or slightly less than the diameter of the Teflon catheter used to extract it. It was easily withdrawn through the puncture site and there were no sequelae. REFERENCES
Fig. 2. A. The "open" appearance of the catheter and wire deflector system is seen as they "hang" on what is thought to be the left hepatic vein. Arrow indicates the embolized catheter. B. The oval configuration of the catheter was achieved by withdrawing the deflector wire approximately 2 em from the tip of the catheter. The larger arrow indicates the tip of the deflector wire.
1. Maxwell DO, Anderson RE: TransfemoraI retrieval of an intracardiac catheter fragment, using a simple hook-shaped catheter. Radiology 103:213-214, Apr 1972 2. Randall PA: Percutaneous removal of iatrogenic intracardiac foreign body. Radiology 102:591-595, Mar 1972 3. McSweeney WJ, Schwartz DC: Retrieval of a catheter foreign body from the right heart using a guide wire deflector system. Radiology 100:61-62, Jul 1971 4. Dotter CT, Rosch J, Bilbao MK: Transluminal extraction of catheter and guide fragments from the heart and great vessels: 29 collected cases. Am J RoentgenoI11:467-472, Mar 1971 5. Rossi P: "Hook catheter," technique for transfernoral removal of foreign body from right side of the heart. Am J Roentgenol 109:101-106, May 1970 6. Miller RE, Cockerill EM, Helbig H: Percutaneous removal of catheter emboli from the pulmonary arteries. Radiology 94:151-153, Jan 1970 7. Henley FT, Ballard JW: Percutaneous removal of flexible foreign body from the heart. Radiology 92:176, Jan 1969 8. Curry JL: Recovery of detached intravascular catheter or guide wire fragments: a proposed method. Am J Roentgenol 105: 894-896, Apr 1969
8). Contrary to the experience of Maxwell and Anderson (1), it was necessary to use the guide wire from a Cook deflector system as described by Rossi (5). Maxwell had successfully
, From the Department of Radiology (R. G. F., Assistant Professor, Director of Special Procedures; J. R. R., second-year radiology resident), Baylor College of Medicine, Texas Medical Center, Houston, Texas 77025. Accepted for publication in April 1975. dk
![[The percutaneous extraction of an embolized Pudenz-Heyer catheter fragment from the pulmonary artery].](/assets/img/hold.png)
