Broken piece in the lungs: A complication of haemodialysis via subclavian cannulation

Abstract

For a total of 349 haemodialysis sessions in 35 patients, 50 special subclavian cannulations were performed. The catheters were implanted infraclavicularly by the Seldinger technique. The average duration of the cannulation period was 26.6 days and the number of dialysis sessions per catheter was 7. Aspects of subclavian cannulation together with indications and complications are described. In three chronically uraemic patients, after 1, 5, and 6 weeks of single-needle haemodialysis, it was noticed that the catheter tip (3-5 cm) inserted into the subclavian vein had broken off. The broken pieces, lodged in the segmental pulmonary arteries, never caused any complication during the observation periods as long as 6, 14 and 33 months. Therefore their removal, either open or transluminal, seemed unnecessary. To prevent complications of similar type it is advisable to avoid single-needle dialysis. Recommended instead is either the double-needle method or the use of a double-lumen catheter.

Where Did the Midline Catheter Disappear?

“…6,7 Although the available reviews recommend immediate removal of a foreign body from the venous system, some authors advocate a conservative approach with radiographic follow up with quantification of the potential complications based on the location of the embolus, especially in asymptomatic patients. 8,9 Although a number of minimally invasive techniques for removing embolus fragments by the percutaneous route are known, 6 due to the risk of failure of these procedures the potential necessity of open surgery remains with all its potential consequences. This emphasizes the importance of prevention of such complications.…”

Percutaneous Extraction of a Catheter Fragment of Totally Implantable Venous Device Migrating into the Left Pulmonary Artery

“…Richardson et al followed 76 cases of retained catheter emboli and found a complication rate of 45% and a mortality rate of 23.7% [7]. Despite these reviews, there exist in the literature arguments for conservative management of catheter emboli particularly asymptomatic patient [8,9]. However, even patients without symptoms may have actively mobile catheter in the future that could provoke lifethreatening complications [10].…”

Hemodialysis Catheter Tip Embolization in the Right Pulmonary Vasculature: Report of a Cardiac Arrest

“…16,17 While searching the literature, we found very few cases of hemodialysis catheter fractures. [12][13][14]18,19 Anuradha et al 13 reported a rare case of spontaneous fragmentation and embolization of a double lumen hemodialysis catheter from the right femoral vein into the inferior vena cava, right atrium, and the superior vena cava. The catheter was subsequently removed percutaneously with success.…”