Purpose or Case Report: Long-term central indwelling catheters are required for multiple treatments in pediatric patients including hemodialysis, parenteral nutrition and chemotherapy. An infrequent complication of these catheters is difficulty at removal or replacement (the “stuck” catheter). Attempted removal of these “stuck” catheters can lead to catheter fracture and retained catheter fragments. These retained catheter fragments can lead to infection, venous thrombosis and ultimately venous stenosis. Given that pediatric patients often require long-term venous access, preservation of venous reserve is critical to the care of these patients. In this exhibit, published literature will be reviewed and a pictorial review of the authors’ clinical experience with “stuck” catheters will be presented.
Methods & Materials: A total of 17 published reports involving the removal of “stuck” catheters in pediatric patients were identified using PubMed and Medline.
Results: A total of 102 pediatric patients were identified in published reports, average age 6.8 years, range 7 months to 17 years. The average catheter age was 40 months. The most common “stuck” Mediport was the Cook 6.5-F silicone catheter in the right internal jugular vein, though most were successfully removed. Amongst, the remaining patients, “stuck” catheters were more often on the left side (25 patients) versus right side (14 patients). Multiple techniques for removal will be reviewed including targeted thrombolysis, sheath over catheter, endoluminal wall dilatation and snare techniques. Preprocedural evaluation, indications for surgical consultation and potential complications will also be reviewed.
Conclusions: Viewers of this exhibit will have an understanding of the management of “stuck” catheters in pediatric patients including risk factors, techniques for removal and potential complications.