Algorithm of Dhanani et al for an Entrapped Central Venous Catheter

The authors are from the Royal Brisbane and Women's Hospital and University of Queensland in Australia.

 

Conditions that can result in a central venous catheter being entrapped:

(1) partial or complete fracture of the original catheter after being speared by the introducer needle and guidewire.

(2) development of a fibrin sheath around the two catheters

 

Diagnostic criteria:

(1) Two central venous catheters are in the same vein.

(2) Difficulty was encountered during the insertion of the second catheter (repeated attempts made, excessive force required, other).

(3) Difficulty has been encountered when trying to remove the original catheter.

(4) X-rays in 2 planes are unable to show a clear separation between the 2 catheters.

 

where:

• Partial rupture is detectable by injecting an intravascular contrast into the original catheter and looking for leakage (mentioned on page 90 but not included in Figure 3, page 91).

 

Management options - one or more of the following:

(1) If a fibrin sheath is suspected, then apply slow and gentle traction to the original catheter over many hours. This approach may be hazardous if there is a fracture in the original catheter.

(2) If a partial fracture is suspected, then an interventional radiologist can try to rotate the original catheter 180 degrees and attempt removal.

(3) Surgical exploration with distal venotomy.

 

If fracture of the original catheter has occurred, then embolization of catheter fragments should be considered, especially if the retrieved catheter is incomplete.

 

Prevention:

(1) Avoid inserting a central venous catheter in the same vein as an existing catheter.

(2) If an insertion of a second catheter is attempted in a central vein that already contains a catheter, then stop immediately if any difficulty is encountered.