GUIDEWIRE-ASSISTED TECHNIQUE TO ASSIST IN SAFE REMOVAL OF CHRONICALLY INDWELLING CENTRAL VENOUS CATHETERS

Objectives: With improvements in medical care and device materials, long-term indwelling catheters are becoming more commonplace, treating a number hematologic and oncologic diseases. Frequently, the implantation of port-based catheter systems may remain indwelling for years, leading to a state of chronic inflammation and fibrosis around the catheter. There are abundant case reports in which the catheter is “stuck” when trying to remove the tract, leading to complications or requiring additional operative techniques for safe extraction such as additional or extended incisions, venous cutdown with venotomy, or dilation. At worst, pulling on the exposed catheter piece can lead to fracture, leaving a remnant piece which may have cardiac embolic potential and on occasion require further interventional vascular procedures to ensnare and remove it.
In this paper we present a case report utilizing a technique we have employed over the past few decades when performing long-term indwelling central venous catheter removal. After externalization of the extravenous catheter, we assess for resistance in removal. If significant force is required or witnessed loss of catheter integrity, a J-tip guidewire is fed through the length of the catheter under fluoroscopy. We believe this serves three beneficial functions: First, it reduces angular kinks in the catheter representing stress points of fracture. Second, it distributes force circumferentially by preventing collapse of the catheter. Third, if the catheter does fracture, the distal portion should remain intubated by the guidewire, theoretically reducing embolic potential and providing more facile retrieval if indicated. Though this does not represent a perfect solution to the “stuck” catheter problem, we believe this technique increases safety and efficacy with easy application.

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