Management of Retained Central Venous Catheters

So today we're going to present the verdict on what should we do with a retained Venus catheter tip? So to recap the case, if you have a catheter that is either retained or fractures and is stuck in the vein, do you go after it by making an incision in the neck? Do you try to retrieve it through interventional radiology or can you leave it alone? So Ian, this is Ian Glenn, my research fellow. So Ian, what is the incidence of this happening? Well in a couple case series looking retrospectively at patients who had catheters removed, anywhere from 5% to 15% of patients are going to require some sort of additional intervention to remove the catheter. So that could be something as simple as enlarging your incision for removing the catheter or something even more complicated or involved such as performing a venotomy, having interventional radiology perform the removal. So 5-15% is kind of the ballpark. The actual number of catheters or catheter fragments that get left behind is going to be from 0.2% to 2%. Okay. So about 2% of the time after putting, removing a catheter, there's going to be retained catheter. Yeah. So at least part of the catheter will be left behind. So who's at risk for this? So looking at again, large case series, the risk factors for catheter retention seem to be patients who have chemotherapy infused through their lines. Patients who have catheters that are indwelling for longer than about a year and a half. And then there seems to be an association with polyurethane catheter material when compared with silastic catheters. Okay. So, and it seems like the power ports for example are polyurethane catheters. So, it seems that if we're going to be maybe putting in a line for long-term chemotherapy, we should be considering maybe a silastic line instead of a polyurethane line. Right. Right. And you know there there was some concern that this association could just be because the majority of catheters put in are polyurethane, but the recommendation would probably be to go with silastic in those cases. Okay. And so what do we do when this happens? So you're taking out the line and it's fractures. You get out half a line. What do you do? So I think you need to look at the risks and benefits of leaving some of the catheter behind versus going after it. If you surgically, if you're going to go in, perform a venotomy and target the catheter, you run into a risk of bleeding. Um in a interventional radiology case series when they tried to go and endovascularly remove the catheters, there was a risk of the line completely breaking and embolizing distally, or of thrombosis occurring during the procedure. And that's a study that we will post here. Okay. Yep. Um and then actually, whenever multiple studies which have looked at patients who actually had retained catheter fragments in follow-up periods from months to the order of five years, there weren't any complications. So no thrombosis associated with the line fragments and no infections. So you might be safe just leaving the catheter fragment behind. So although we don't have really long-term follow-up, there's really yet nothing been reported with a problem with leaving the catheter in. Exactly. Okay. So here's our recommendation based on the literature review. First of all, when putting in a new line, if you think that it's going to be a long-term line for chemotherapy, you may want to choose a silastic line instead of polyurethane. Keep in mind that the silastic line will generally have a larger size diameter for a given lumen. If a catheter fractures, it seems like it's dealer's choice. You can go ahead and try to do a neck incision or do interventional radiology. Those do carry a risk of bleeding or dislodging the line and embolizing it. It looks like there has never been a report of a problem by leaving the catheter tip in, although we don't really have long-term data. Again, I want to thank Ian Glenn for doing this literature review and also Samir Pandya who helped us get some of these articles about retained catheters. Thanks.