Register for citation alerts

Retained fragments of CVC and late fatal central venous catheter sepsis

"This case shows that these retained intravascular fragments can cause fatal complications on the long-term" Ottevanger et al (2020).

Abstract:

Introduction: Central venous catheters (CVC) are associated with risks and complications. Complications like vessel perforation, thrombosis, infection with significant morbidity and mortality, knotting, and ventricular perforation have been described. Another less-frequent complication is retained CVC fragments. We present a case of a very late but fatal complication after a CVC placement. This report is written in line with the consensus-based surgical case report guidelines (SCARE).

Case: A 46-year-old male presented to the emergency department in a critical (septic) shock. The patients’ medical history featured a long-intensive care admission 28 years ago. The cause of this sepsis was not evident until a computed tomography scan was performed to exclude a pulmonary embolism, revealing a remnant of a central catheter in both pulmonary arteries. Despite extensive resuscitation, the patient died within 24 hours after admission. An autopsy was performed confirming that the catheter remnant was the only possible cause of the fatal sepsis.

Discussion: CVC’s are associated with (fatal) complications; however, retainment of remnants are described unfrequently but do occur in almost 2% of the cases. Endovascular removal of these remnants has been performed successfully and should be the first treatment of choice if removal is considered. No evidence is available that suggests that routine removal has to be attempted but some longer term complications can be expected, so awareness of possible remnants after CVC removal should exist.

Conclusion: Retained fragments of CVC’s are rare but are described after prolonged use. This case shows that these retained intravascular fragments can cause fatal complications on the long-term. Upon removal of CVC’s, there should be awareness that retainment of fragments can occur.

Reference:

Ottevanger R, Loggers SAI, Yapici U, Meijer JMR, Koning GG. An Unexpected Case of Late Fatal Central Venous Catheter Sepsis: A Case Report. Surg J (N Y). 2020;6(3):e153-e156. Published 2020 Sep 10. doi:10.1055/s-0040-1713415