title: Something's missing: peripheral intravenous catheter fracture.
abstract: We describe a case of peripheral intravenous catheter fracture occurring during a routine training exercise. The supervising instructor immediately placed a venous tourniquet proximal to the insertion site and urgently transported the patient to the hospital. The missing catheter segment was identified within the median cubital vein under ultrasonography and was removed by venous cutdown under local anesthesia. An investigation determined that reinsertion of the needle into the advanced catheter likely caused the fracture and that application of a tourniquet may have prevented embolism of the fractured segment. Our literature review suggested that peripheral intravenous catheter fracture is likely vastly underreported, with only one prior case identified in the English literature. Action was taken following the event to educate all Israeli Defense Force medical providers regarding both proper preventive measures and recognition and treatment of catheter fracture should it occur. This case highlights the importance of health care providers being aware of the possibility of catheter fracture, as well as steps to take to prevent and mitigate its occurrence.
authors.affiliation: the Trauma and Combat Medicine Branch, Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel; and the Navy, Israel Defense Forces, Haifa Israel.
authors.forename: Elon
authors.initials: E
authors.lastname: Glassberg
authors.forename: Gadi
authors.initials: G
authors.lastname: Lending
authors.forename: Benyamine
authors.initials: B
authors.lastname: Abbou
authors.forename: Ari M
authors.initials: AM
authors.lastname: Lipsky
mesh_terms: D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation*; D020878:Device Removal / Q000379:methods; D004868:Equipment Failure; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006225:Hand / Q000098:blood supply; D006801:Humans; D008889:Military Personnel / Q000193:education*; D014463:Ultrasonography; D062666:Vascular Access Devices / Q000009:adverse effects*; D014680:Veins; D055815:Young Adult
keywords: Case Reports; Embolism; Peripheral Venous Catheter; Procedures