What is the incidence risk of complications from retained intravenous (IV) catheter fragments?

From the Guidelines

The incidence risk of complications from retained intravenous (IV) catheter fragments is a serious concern that warrants immediate attention and removal to prevent potential life-threatening complications. Specific risks associated with retained IV catheter fragments include:

• Thrombosis
• Infection
• Embolization to heart or lungs, which can be potentially life-threatening, as noted in the association of anaesthetists of great britain and ireland: safe vascular access 2016 guidelines 1 If a catheter fragment is suspected to be retained:

1. Confirm with imaging (X-ray or CT scan)
2. Consult interventional radiology for removal, typically via endovascular techniques
3. If endovascular removal fails, surgical intervention may be necessary To minimize risks:

• Use proper catheter insertion and removal techniques, such as minimising the length of guidewire advanced and maintaining hold of the outside section, as recommended by the association of anaesthetists of great britain and ireland: safe vascular access 2016 guidelines 1
• Inspect catheters for integrity before and after use
• Implement protocols for identifying and managing retained catheter pieces, including guidewire counts or mandatory witnessed documentation of guidewire removal, as suggested by the association of anaesthetists of great britain and ireland: safe vascular access 2016 guidelines 1 The potential severity of complications necessitates prompt action when fragments are identified, as retained pieces can act as a nidus for thrombus formation or bacterial colonization, leading to more severe sequelae if left untreated, highlighting the importance of urgent radiological or surgical retrieval, as noted in the association of anaesthetists of great britain and ireland: safe vascular access 2016 guidelines 1

From the Research

Incidence Risk of Complications from Retained IV Catheter Fragments

• The incidence risk of complications from retained IV catheter fragments is relatively low, with one study [ 2 ] reporting a 2% incidence rate of retained intravascular fragments after attempted removal of central venous lines.
• Another study [ 3 ] found that in patients with retained CVCs, no complication arose from this condition, with a mean follow-up period of 36 months.
• A study on peripherally inserted central catheters (PICCs) [ 4 ] reported an incidence rate of complications of two cases per 1000 days of catheter duration, with the most relevant complications being infection and thrombosis.
• A study on totally implantable venous ports [ 5 ] reported two cases of retained catheter fragments, with both patients remaining asymptomatic after 1 year of follow-up.
• A multi-institutional review [ 2 ] found that retained intravascular fragments after attempted removal of central venous lines did not result in any symptoms, evidence of thrombus, infection, or catheter migration, with an average follow-up period of 5.4 years.

Types of Complications

• The potential complications arising from the presence of retained CVCs fragments include:
  • Infection [ 3, 4, 6 ]
  • Venous thrombosis [ 3, 4, 6 ]
  • Catheter migration [ 3, 4 ]
  • Embolism [ 6 ]
  • Intracranial hemorrhage [ 6 ]
  • Major bleeding [ 6 ]
  • Mechanical catheter-related complications [ 6 ]

Patient Population

• The risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters [ 6 ].
• Patients with cancer at baseline had significantly higher incidence rates for catheter-related bloodstream infections and thrombosis than non-cancer patients [ 6 ].
• CVC or HD catheter-related complications were most frequently seen in patients 16 years or younger [ 6 ].