Short Case Report
We welcome short report from illustrative clinical cases
Report 1:
Transvenous Recovery of a Cut subclavian Catheter
A 92 year old patient was put on haemodialysis using a double lumen subclavian catheter pending the maturation of her fistula. One day she thought the catheter was causing itchiness and she cut the exposed part of the catheter herself. Her relatives immediately tried to stop the bleeding with local pressure using a gauze pad, and the rest of the catheter was pushed below the skin. A surgeon was called in and he could not find the catheter along the tract.
We asked for the assistance of the interventional radiologist.
A femoro-venous approach was utilized to capture the loose catheter. A sheath was positioned in the inferior vena cava. A gooseneck snare was introduced. It was not possible to capture the distil end of the catheter which was abutting the lateral wall of the right atrium.
An attempt was made to pass the snare into the right subclavian vein to snare the proximal end of the loose catheter but resistance was felt. Contrast injection confirmed the presence of thrombus.
A pigtail catheter with the pigtail in horizontal direction was utilized to dislodge the loose catheter from the adjacent fibrin. Using this catheter, it is possible to dislodge the catheter and pull it downwards. The tip of the catheter appeared to be impacted against the wall of the atrium and proximal end of the loose catheter was relocated into the left subclavian vein. In this position, a gooseneck snare could engage the proximal end. The gooseneck was subsequently slide down the distil end of the catheter. The catheter tip was disimpacted and the catheter brought down into the inferior vena cava and out through the femoral vein.
The subsequent dialyses of this patient were non-eventful.
Dr Jimmy P K Lee, MBBS, FRCR, FRACR, FHKAM (Radiology)
Dr C P Ho, MBBS, FRCP (Edin) FRCP (Glas), FHKAM (medicine)
