Ufuk ATEŞ, Nil Yaşam TAŞTEKİN, Fuad MAMMADOV, ERGUN ERGÜN, Gülnur GÖLLÜ, Özlem Selvi CAN, Tayfun UÇAR, Meltem BİNGÖL-KOLOĞLU, Aydın YAĞMURLU, Tanju AKTUĞ

Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance

Adherent tunneled catheters can usually be removed by a surgical cut down,but in some cases the line can become stuck to the wall of the central veins.In such cases, forceful traction can cause vascular injury, or fracture of thecatheter. We present four cases of fixated cuffed tunneled catheters. Threechildren had acute lymphoblastic leukemia and one had an immunodeficiencysyndrome. All catheters were made from polyurethane. Indwelling times were12-24 months. All patients’ catheters were removed with great difficulty bytrans-femoral access. The angiography-assisted technique is safe and easilyapplied for the removal of stuck catheters in pediatric patients. These casesraise important questions concerning the maximum indwelling time andthe choice of catheter material when implanting permanent central venouscatheters (CVCs) in children.

PDF

___

1. Hastings C. The Children’s Hospital Oakland Hematology. Oncology Handbook. Mosby, 2002: 47-55.

2. Maizlin I, Carpentier H, Bliss D. Difficult extraction of long-term central venous catheters in children-case report. J Pediatr Surg 2010; 45: 1720-1723.

3. Milbrandt K, Beaudry P, Anderson R, Jones S, Giacomantonio M, Sigalet D. A multiinstitutional review of central venous line complications: retained intravascular fragments. J Pediatr Surg 2009; 44: 972- 976.

4. Field M, Pugh J, Asquith J, Davies S, Pherwani AD. A stuck hemodialysis central venous catheter. J Vasc Access 2008; 9: 301-303.

5. Pisoni RL, Arrington CJ, Albert JM, et al. Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis 2009; 53: 475-491.

6. Rehman R, Schmidt RJ, Moss AH. Ethical and legal obligation to avoid long-term tunneled catheter access. Clin J Am Soc Nephrol 2009; 4: 456-460.

7. Kılıç S, Soyer T, Karnak İ, Çiftçi AÖ, Tanyel FC, Şenocak, ME. Evaluation of the removal reasons of totally implantable venous devices in children: a retrospective study. Turk J Pediatr 2016; 58: 187-194.

8. Suhocki PV, Conlon PJ Jr, Knelson MH, Harland R, Schwab SJ. Silastic cuffed catheters for hemodialysis vascular access: thrombolytic and mechanical correction of malfunction. Am J Kidney Dis 1996; 28: 379-386.

9. Forneris G, Savio D, Quaretti P et al. Dealing with stuck hemodialysis catheter: state of the art and tips for the nephrologist. J Nephrol 2014; 27: 619-625.

10. Hassan A, Khalifa M, Al-Akraa M, Lord R, Davenport A. Six cases of retained central venous haemodialysis access catheters. Nephrol Dial Transplant 2006; 21: 2005-2008.

11. Carrillo RG, Garisto JD, Salman L, Merrill D, Asif A. A novel technique for tethered dialysis catheter removal using the laser sheath. Semin Dial 2009; 22: 688-691.

12. Serrano M, García-Alix A, López JC, Pérez J, Quero J. Retained central venous lines in the newborn: report of one case and systematic review of the literature. Neonatal Netw 2007; 26: 105-110.

13. Gladman G, Sinha S, Sims DG, Chiswick ML. Staphylococcus epidermidis and retention of neonatal percutaneous central venous catheters. Arch Dis Child 1990; 65: 234-235.

14. Huang SC, Tsai MS, Lai HS. A new technique to remove a “stuck” totally implantable venous access catheter. J Pediatr Surg 2009; 44: 1465-1467.

15. Lesher AP, Kratz JM, Smith CD. Removal of embedded central venous catheters. J Pediatr Surg 2008; 43: 1030-1034.