Self-inflicted and iatrogenic peripheral intravenous cannula fracture: A case report

Abstract

IntroductionWe present a case of broken peripheral intravenous catheter/cannula (PIVC), a well-known, underreported complication of PIVC placement. The fractured cannula could have resulted in intravascular foreign body retention, which is usually iatrogenic.Presentation of caseIn this case, we conceded that both iatrogenic and self-infliction were culpable. The intoxicated, aggressive patient forcefully removed the inserted cannula after repeated attempts by medical personnel to place it. The same cannula was used for multiple attempts. After the location of the fractured catheter was reconfirmed with radiological imaging, venotomy and removal of the foreign body were performed.ConclusionDue to potentially devastating consequences, early detection, adherence to standard operating procedures for peripheral venous access, management of aggressive patients, and meticulous teamwork must be upheld.

CT-guided retrieval of a fractured intravenous cannula in a toddler: A case report

“…Unlike in other reports [ 10 , 12 ], the fragment was not palpable in our case. Uncertainty of its location, coupled with its miniature dimensions that would have made it easier to embolize, made us fear it had embolized proximally in the limb as reported by Bloom et al [ 13 ] or even into the chest with potentially life-threatening outcomes as reported by some authors [ [3] , [4] , [5] , [6] ].…”

“…Similar to other reports [ 9 , 10 ], repeated insertion of the same cannula, which is again a common practice in this resource-limited setting, might have contributed to material failure. The needle could also have punctured the tubing sometime during the procedure similar to what Glassberg et al [ 11 ] and Dell'Amore et al [ 3 ] suggested.…”

“…However in all cases of palpable fragments, it is necessary to prevent embolization pending urgent removal. A tourniquet is commonly applied proximally to prevent embolization [ 11 , 12 ] while, if the fragment is in the hand, wrist dorsiflexion and splinting can prevent embolization [ 10 ]. In our case, we did not attempt to prevent embolization since we were not certain of the fragment's location.…”

“…Glassberg et al used ultrasonography [ 11 ] while Khoo et al used radiographs [ 10 ] to image the fragment. In our case, both modalities failed probably because of the small gauge of the cannula which could only be picked by the high resolution and three-dimensional capabilities of CT.…”

Broken Intravenous Angiocath – A Case Series

“…[1] Spontaneous fracture and migration of intravenous cannula is a rare but known complication first described by Turner et al in 1954. [2] Quality of materials, repeated attempts of catheterization with the same cannula [3] , uncooperative patients and direct trauma to the IV line while in situ are thought to contribute to the incidence of fractured IV cannula [4] . This risk can be reduced by adhering to guidelines, avoiding repeated attempts with the same cannula, avoiding lower extremity IV placement, minimizing catheter movement, placing the smallest suitable catheter size, and removing the catheter as soon as possible.…”