From the Guidelines
Retained intravenous (IV) catheter fragments pose significant risks and should be removed promptly to prevent complications such as thrombosis, infection, vascular damage, and embolization. The main complications associated with retained IV catheter fragments include:
- Thrombosis: Catheter fragments can cause blood clots, potentially leading to deep vein thromosis or pulmonary embolism.
- Infection: Retained pieces can become a breeding ground for bacteria, causing local or systemic infections.
- Vascular damage: Sharp edges may damage blood vessel walls, leading to bleeding or further complications.
- Embolization: Fragments can migrate to other parts of the body, potentially causing blockages in vital organs like the heart or lungs.
- Chronic pain or discomfort at the site of retention. According to the most recent and highest quality study available, immediate medical attention is crucial if a catheter piece is suspected to be retained 1. Imaging studies like X-rays or CT scans should be performed to locate the fragment. Removal is typically done via minimally invasive endovascular techniques, but open surgery may be necessary in some cases. Prevention is key, and healthcare providers should follow proper catheter insertion and removal protocols, and patients should be educated about the importance of careful catheter handling and prompt reporting of any issues, as recommended by the guidelines for the prevention of intravascular catheter-related infections 1. The risks associated with retained IV catheter fragments are due to the foreign nature of the catheter material in the body and its potential to interact with blood and tissues, causing mechanical and biological disruptions to normal physiological processes, as highlighted in the association of anaesthetists of Great Britain and Ireland: safe vascular access 2016 guidelines 1. It is essential to prioritize the removal of retained IV catheter fragments to minimize the risk of complications and ensure the best possible outcome for patients, as emphasized in the espghan/espen/espr/cspen guidelines on pediatric parenteral nutrition: complications 1.
From the Research
Risks of Complications from Retained Intravenous (IV) Catheter Fragments
The presence of retained IV catheter fragments can lead to various complications, including:
- Infection: Retained catheter fragments can serve as a nidus for infection, potentially leading to catheter-related bloodstream infections 2, 3, 4.
- Venous thrombosis: The presence of a retained catheter fragment can increase the risk of venous thrombosis, which can be a serious complication 2, 5.
- Catheter migration: Retained catheter fragments can migrate to other parts of the body, potentially causing damage to surrounding tissues or organs 2, 6.
- Cerebral infarction: In rare cases, retained guidewires can migrate to the cerebral circulation, leading to cerebral infarction 6.
Factors Contributing to Complications
Several factors can contribute to the development of complications from retained IV catheter fragments, including:
- Duration of catheter placement: Longer durations of catheter placement increase the risk of complications 2, 4.
- Type of catheter: Different types of catheters, such as central venous catheters and peripherally inserted central venous catheters, may have varying risks of complications 4.
- Insertion site: The site of catheter insertion can also impact the risk of complications, with peripheral catheter tip positions being associated with a higher risk of unplanned catheter removal 4.
- Patient status: Certain patient factors, such as surgical status, can also influence the risk of complications 4.