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• W1966320377 abstract "Complications relating to the siting and lifespan of indwelling central venous catheters (CVC) have been reported. Complications that occur during removal are less known, but of equal importance. One retrospective review of removal of Broviacs, Port-A-Caths and Hickmans noted a 2% incidence of broken retained lines in the superior vena cava, innominate vein or bracheo-cephalic junction [1]. Causes include shearing by the needle or guide wire during insertion [2, 3], mechanical movement between the first rib and the clavicle [4], high pressure during bolus injection [2], trauma from the tricuspid valve or contracting right ventricle [5] and formation of a fibrin sheath around the catheter [6]. Consequences of fragmentation include retention in a thrombus sheath or embolisation. We wish to highlight concerns raised by the surgical team over the removal of a Hickman line. It had been placed in a patient 6 months earlier under X-ray guidance by a radiologist, and was cut to the appropriate length for the patient. The line was removed by the surgical specialist registrar under local anaesthesia, with careful dissection. It was noted to be difficult to extract and possibly ‘stuck down’. After removal there was concern over the cut distal segment of the line and the possibility of fragmentation of the lumen and potential retention and embolisation. There were no markings of length or distal tip markings to alert us to fragmentation. We wonder whether it would be possible for practitioners or manufacturers to develop a system to prevent confusion at the time of line removal. Possible solutions include simply measuring the length of the remaining line from the hub, or application of ascending length markings on the line from the hub to the distal end. This could then be recorded in the patient's notes. Alternatively it may be possible to purchase varying fixed length catheters with length markings and a distal coloured tip, thus adopting the system used for some central venous and epidural catheter sets to prevent such confusion upon line extraction." @default.
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• W1966320377 date "2007-06-01" @default.
• W1966320377 modified "2023-09-27" @default.
• W1966320377 title "Preventing confusion due to possibly retained long lines" @default.
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• W1966320377 doi "https://doi.org/10.1111/j.1365-2044.2007.05122.x" @default.
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