Use of a Guide-wire as an Adjunct for the Safe Removal of a ‘Stuck’ Indwelling Central Venous Catheter at Risk for Breaking

Author:

Urevick Alexander J.1,Briscoe W. Eric1,Harpstead Edward1,Koontz Curtis S.1,Bhattacharya S. Dave1

Affiliation:

1. Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Chattanooga, TN, USA

Abstract

Port-based central venous catheters may remain indwelling for years with subsequent fibrosis resulting in a “stuck” catheter. At time of removal, this can lead to complications such as catheter fracture or require additional operative techniques for safe extraction. We present a case utilizing a protocol wherein a J-tip guidewire is placed to assist in removal. We believe this serves the following beneficial functions: Mechanically, as the catheter stretches and collapses upon retraction it distributes the force circumferentially along the length of the catheter as well as reduces angular kinking, mitigating stress points of fracture. Second, in case of fracture, the distal portion should remain intubated by the J-tip guidewire, reducing embolic potential. Third, it allows more facile percutaneous transvenous retrieval if indicated. Though this does not represent a perfect solution to the “stuck” catheter problem, this technique increases safety and efficacy of removal with easy application at minimal additional cost.

Publisher

SAGE Publications

Subject

General Medicine

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