Retained intravascular catheter fragment at removal of implantable vascular access device: Incidence, risk factors, and outcomes

Infographic · May 2022 · 1 min read

In brief

Retrospective study of 654 IVAD removals in pediatric patients found retained catheter fragments occurred in 0.92% of cases, with risk increasing significantly after 3 years of catheter duration. Conservative management with in-situ retention was successful in most cases, suggesting invasive retrieval procedures are rarely warranted for this complication.

Retained catheter fragments occur in 0.92% of IVAD removals, with risk increasing 3.5-fold per year of indwelling time.
No retained fragments occurred in IVADs indwelling less than 3 years; greatest risk is in lines placed longer than 3 years.
Conservative management (leaving fragments in situ) is safe in pediatric patients, with most remaining asymptomatic long-term.
Invasive endovascular retrieval is rarely needed and should be reserved for symptomatic cases like infection.
Transfixion of retained fragments to surrounding muscle is a prudent management strategy to prevent migration.

Written by the GCMD Library team from the infographic.

The infographic uses a left-to-right flow with three main sections separated by vertical dividers. Icons include a patient silhouette with heart and catheter, a curved catheter illustration, a calendar with clock, a magnified port device, and a clinician figure. The color scheme uses teal accents on white background with a red header bar.

Background

Retained intravascular catheter fragments (RICF) are a rare complication of implantable vascular access device (IVAD) removal for which there is limited understanding of aetiology. There is a varied approach to management among the currently published literature.

Aims

The aim of this study was to establish incidence, risk factors, and outcomes for RICF after attempted removal of IVADs.

Methods

A single institution retrospective review was undertaken of individuals ≤ 25 years undergoing removal of IVADs from October 2014 to June 2019. Risk factors for RICF were explored using univariable logistic and Cox regression analysis.

Results

Six cases of RICF were identified among 654 line removal episodes (0.92% (95% CI 0.37–2%)) in patients aged 6–17 years (median 11, IQR 6–15 years). The main risk factor for RICF at removal was found to be line duration (OR 3.5/year, 95% CI 2.1–5.84, p < 0.0001). No RICFs occurred in lines indwelling for < 3 years. Five children with RICF ≤ 16 years were discussed with a paediatric cardiothoracic centre, and all were left in situ with 4 remaining asymptomatic. One had the fragment tip extruded through a wound, which required trimming. The other (17 years of age) developed an infected sinus for which partial removal with open excision followed by full removal with endovascular snare retrieval was performed by the adult vascular surgeons.

Conclusion

IVADs in-situ for longer than a three-year period are at greatest risk of RICF upon removal. Management with transfixion of line fragments to surrounding muscle seems prudent while invasive attempts at retrieval appear unwarranted.

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