Abstract: FR-PO540
Rare Complication of Hemodialysis Catheter Insertion: Tissue Dilator Embolism
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Sim, Jasper, Albert Einstein College of Medicine, Bronx, New York, United States
- Das, Sajan, Montefiore Medical Center, New York, New York, United States
- Gupta, Sonali, Albert Einstein College of Medicine, Bronx, New York, United States
Introduction
Central line catheterization is one of the most common invasive procedures performed. Of the potential complications, mechanical complications are often overlooked given the assumption of device integrity. While catheter fragmentation has been previously reported in literature, there has only been one reported case of a tissue dilator fracture and embolism during femoral catheterization. In this case report, we describe a tissue dilator fracture and embolism during left internal jugular vein catheterization.
Case Description
A 55-year-old male with non-ischemic cardiomyopathy and prior LVAD placement was admitted with biventricular heart failure and underwent RVAD. Hospital course was complicated by persistent cardiogenic shock, hypoxic respiratory failure, volume overload and acute respiratory distress syndrome. It was decided to begin slow continuous ultrafiltration to manage his volume status. During an attempt to obtain vascular access, the tissue dilator tip fractured and migrated to the right pulmonary artery. Interventional radiology attempted retrieval of the foreign body but was unable to retrieve it after multiple snare attempts. Procedure was complicated by hemorrhage requiring embolization of the right pulmonary artery branch. Over the next few days, the patient remained hemodynamically unstable, and the family eventually decided to withdraw care.
Discussion
Our case highlights how a simple, routine procedure can be associated with grave complications. There are occasional reports of vascular catheter tips or guidewire fragmentation, but dilator tip fragmentation is rare. It is important to note the expiration date and integrity of instruments and devices, such as the guidewire, catheter, and dilator, before use. It is also crucial to ensure all devices used for a vascular procedure contain a radiopaque marker for rapid identification in the case of fragmentation. As retained foreign bodies increase the risk for sepsis, hemorrhage, embolism, cardiac arrythmia and mortality, retrieval should be done promptly after discovery. In this case, the foreign body failed to be recovered despite minimally invasive methods.