What is the management for a broken midline catheter left inside a vein?

Management of Broken Midline Catheter Left Inside Vein

For a broken midline catheter left inside a vein, urgent referral to interventional radiology or vascular surgery for retrieval is required to prevent potential complications such as thrombosis, embolization, or infection. 1

Assessment and Initial Management

• Immediately document the event, including the estimated length and location of the retained catheter fragment 1
• Obtain appropriate imaging (typically chest X-ray or fluoroscopy) to confirm the location of the broken catheter fragment 1
• Monitor vital signs and assess for any symptoms of complications (e.g., chest pain, shortness of breath, arrhythmias) 1
• Do not attempt to remove the fragment by applying traction or manipulation at the insertion site 1

Definitive Management

• Percutaneous retrieval by interventional radiology is the preferred first-line approach 1, 2

  • Techniques may include snare devices, balloon catheters, or specialized retrieval tools 2
  • Portable fluoroscopy is typically used to guide the retrieval procedure 3

• If percutaneous retrieval is unsuccessful or contraindicated, surgical removal may be necessary 1

  • The decision between continued attempts at percutaneous retrieval versus surgical intervention should be made in consultation with vascular surgery 1

Special Considerations

• For very small fragments in peripheral locations with low risk of migration, a conservative approach with observation may be considered in select cases 1

  • This decision should only be made after consultation with interventional radiology or vascular surgery 1

• For fragments that have migrated to the heart or pulmonary vasculature, urgent intervention is required due to higher risk of serious complications 1

• Fibrin sheaths may form around long-term catheters and can be seen as "ghosts" on ultrasound after removal; these are distinct from actual catheter fragments and generally do not require intervention 1

Prevention of Catheter Breakage

• Avoid applying excessive force during catheter insertion or removal 1
• Never use scissors near catheters during dressing changes 1
• Avoid chemical damage to catheters by using only compatible solutions (avoid organic solvents with silicone catheters and inappropriate use of ethanol with polyurethane catheters) 1
• Do not use midline catheters for high-pressure injections (e.g., contrast for CT/MRI) unless specifically designed and labeled for such use 1
• Ensure proper catheter stabilization to prevent excessive movement that could lead to material fatigue 1

Follow-up After Retrieval

• Confirm complete removal of all fragments with post-procedure imaging 1
• Document the event thoroughly in the patient's medical record 1
• Consider alternative vascular access options if continued therapy is needed 4, 5
• Monitor for delayed complications such as vascular damage, thrombosis, or infection 1