title: A stuck haemodialysis central venous catheter: not quite open and shut!
abstract: Removal of tunnelled central venous catheters can become complex if left in situ for a prolonged period. We report a challenging case of a stuck tunnelled haemodialysis catheter, which required sternotomy with cardio-pulmonary bypass for retrieval. A 47-year-old female had failed attempts to remove the venous limb of a Tessio line on the ward. A cut down on the internal jugular vein and division of the fibrin sheath failed to release it. Synchronous traction was applied via a snare inserted through a femoral approach. On table trans-oesophageal echocardiogram showed the tip of the catheter traversing the tricuspid valve. At sternotomy with cardio-pulmonary bypass, the tip of the catheter was found attached to the septal leaflet of the tricuspid valve requiring release and repair. The management of stuck line has potential serious complications. Prophylactic catheter exchange should be considered to avoid complications.
authors.affiliation: Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK sjafferbhoy@doctors.org.uk.
authors.forename: Sadaf F
authors.initials: SF
authors.lastname: Jafferbhoy
authors.affiliation: Department of Radiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: John R
authors.initials: JR
authors.lastname: Asquith
authors.affiliation: Department of Anaesthesia, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Ravish
authors.initials: R
authors.lastname: Jeeji
authors.affiliation: Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Levine
authors.affiliation: Department of Renal Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Madhavan
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Arun D
authors.initials: AD
authors.lastname: Pherwani
references.citation: Semin Dial. 2009 Nov-Dec;22(6):688-91
references.pmid: 20017840
references.citation: Am J Kidney Dis. 1996 Sep;28(3):379-86
references.pmid: 8804236
references.citation: Acta Anaesthesiol Scand. 2010 Jul;54(6):777-80
references.pmid: 20455871
references.citation: Am J Kidney Dis. 2006 Jul;48 Suppl 1:S176-247
references.pmid: 16813989
references.citation: Ren Fail. 2003 May;25(3):431-8
references.pmid: 12803506
references.citation: Nephrol Dial Transplant. 2006 Jul;21(7):2005-8
references.pmid: 16632560
references.citation: Nephrol Dial Transplant. 2007 Mar;22(3):960-1; author reply 961
references.pmid: 17192277
references.citation: J Vasc Interv Radiol. 2004 May;15(5):497-9
references.pmid: 15126661
references.citation: J Vasc Access. 2008 Oct-Dec;9(4):301-3
references.pmid: 19085904
references.citation: J Vasc Access. 2009 Jan-Mar;10(1):50-4
references.pmid: 19340800