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LETTERS TO EDITOR
Year : 2018  |  Volume : 12  |  Issue : 3  |  Page : 504-505

Fracture and embolization of intravenous cannula placed in external jugular vein: A rare complication


Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Correspondence Address:
Dr. Chitta Ranjan Mohanty
Qtr No. 303, Type V AIIMS Residential Complex, All India Institute of Medical Sciences, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_289_18

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Date of Web Publication2-Jul-2018
 


How to cite this article:
Mohanty CR, Panda R. Fracture and embolization of intravenous cannula placed in external jugular vein: A rare complication. Saudi J Anaesth 2018;12:504-5

How to cite this URL:
Mohanty CR, Panda R. Fracture and embolization of intravenous cannula placed in external jugular vein: A rare complication. Saudi J Anaesth [serial online] 2018 [cited 2018 Jul 20];12:504-5. Available from: http://www.saudija.org/text.asp?2018/12/3/504/235754



Sir,

External jugular vein (EJV) is commonly used for venous manometer and catheterization when peripheral venous assess is difficult. Though central venous assess is the preferred method in emergency setting, sometimes, EJV is cannulated with 16G or 18G intravenous cannula and secured in place with the help of sterile dressing and a 3-way stopcock attached to prevent air migration. Catheter fracture and embolization is a rarely reported complication of central venous and peripherally inserted central venous cannula.[1],[2] We report the first instance of intravenous cannula fracture in our institute placed in EJV and distal migration toward clavicle.

Our patient is a 65-year-old female admitted in the Intensive Care Unit (ICU) and was inserted 18G cannula in the left EJV due to difficulty in obtaining peripheral venous assess and was to be removed by staff nurse at the time of patient discharge. During its removal, the catheter broke at its hub and it remained within the vein which was palpable. Due to late hours, exploration was planned the next day. There was gradual distal migration of the segment due to patient movement. Ultrasound could not detect the fractured segment. Computed tomography scan was done in which the fracture segment was visible in supraclavicular region at medial third of left clavicle [Figure 1] and [Figure 2]. The fractured segment was removed at the junction of thrombosed EJV and subclavian vein by surgical intervention (there was no interventional radiologist).[3],[4]
Figure 1: Sagittal section showing position of foreign body (fractured canula) in relation to clavicle

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Figure 2: Axial section showing foreign body in relation to clavicle

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Rupture and distal migration of intravenous cannula can occur when there is prolonged catheterization, poor quality of intravenous cannula, and Not careful while removing catheter. Health-care workers in ward, ICU, and emergency department should be aware of the complications of intravenous cannula fracture and migration. Proper care should be taken during removal of catheters placed in central veins to avoid potentially serious complication of catheter migration and, if occurs, immediate steps have to be taken.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Courcoux MF, Jouvet P, Bonnet D, Iserin F, Bonhoeffer P. Intravascular rupture of a central venous catheter in a premature infant: Retrieval by a nonsurgical technique. Arch Pediatr 2000;7:267-70.  Back to cited text no. 1
[PUBMED]    
2.
Linz DN, Bisset GS 3rd, Warner BW. Fracture and embolization of a peripherally inserted central venous catheter. JPEN J Parenter Enteral Nutr 1994;18:79-80.  Back to cited text no. 2
    
3.
Hayari L, Yalonetsky S, Lorber A. Treatment strategy in the fracture of an implanted central venous catheter. J Pediatr Hematol Oncol 2006;28:160-2.  Back to cited text no. 3
[PUBMED]    
4.
Dondelinger RF, Lepoutre B, Kurdziel JC. Percutaneous vascular foreign body retrieval: Experience of an 11-year period. Eur J Radiol 1991;12:4-10.  Back to cited text no. 4
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    Figures

  [Figure 1], [Figure 2]



 

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