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For a well selected group of children, day-case tonsillectomy in a district hospital setting is a safe and efficient alternative to an in-patient stay. A dedicated day-case team, good anaesthetic technique, adequate post-operative analgesia and on-site paediatric in-patient facilities are essential.

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Background Migration of central venous catheters is a rare but serious complication. The endovascular approach has been widely used for the retrieval of such fragment, with the two-step technique used for removal of catheter fragments with inaccessible ends. In this case report, we describe a modification of this technique that was used after first attempting the two-step technique unsuccessfully. Case presentation A 42-year-old female with breast cancer had a chemoport inserted for chemotherapy. After 6 cycles of chemotherapy the port could not be flushed and a chest radiograph demonstrated a migrated catheter fragment. CT scan demonstrated that one end of the fragment was in the liver in the middle hepatic vein and the other in the right atrial appendage. A modified 2 step technique, using a pigtail catheter, hydrophilic wire and snare was used to remove this fragment. Conclusion In this case report we highlight a new modification of the 2-step technique that can be employed when the conventional 2 step technique does not work.