Retrieval of a dislodged porth catheter with inaccessible tips in a pediatric cancer patient,CVIR Endovascular

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Retrieval of a dislodged porth catheter with inaccessible tips in a pediatric cancer patient
CVIR Endovascular ( IF 1.2 ) Pub Date : 2021-06-15 , DOI: 10.1186/s42155-021-00241-7
Murat Dökdök ₁

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To the Editor,

We read the article entitled “Pigtail through snare technique: an easy and fast way to retrieve a catheter fragment with inaccessible ends” with great interest. Here, a modified technique, hooking the catheter fragment with a pigtail catheter advanced through the snare loop, is described by the authors to retrieve the catheter fragment with inaccessible ends in a prompt fashion (Mori et al. 2021). Dislodged venous catheter fragments are retrieved successfully by interventional radiologists for decades using mainly two methods: loop snare or grasping forceps. Besides, other modified adjunct methods with catheters and wires have also been described in the literature. To our best knowledge, using a pigtail catheter positioned to the optimal site when there were no free ends of the catheter was first described by Cheng et al. (2009). They also had utilized basket successfully in patients when tips of the fragments were inaccessible.

There are some other single-center experiences, including relatively small case series in the literature; most of them focus on the materials and complications; none but one reports fluoroscopy time and radiation doses (Kalińczuk et al. 2016). In this study, the median fluoroscopic time reported is 6.1 min (0.47–42.0), while the maximum dose in the longest procedure entrance skin exposure is 912 mGy. However, no specific data was given related to the catheter fragment tip accessibility. We just recently retrieved a dislodged venous port catheter with inaccessible tips in an 8-year old girl who has been treated with medulloblastoma. Venography revealed an embedded proximal catheter tip in the right internal jugular vein wall and an inaccessible distal catheter tip in the right ventricle wall without any free movements. We used a 5 Fr pigtail catheter and 0.035″ wire to hook up the central portion of the port catheter, similar to the authors. Then the silicon port catheter was withdrawn from inferior vena cava with 20 cm Amplatz GooseNeck Snare (Medtronic, USA) through the 6F catheter lumen readily. The fluoroscopy time (57 min), air kerma was kept relatively low (734 mGy) using collimators. Compared to radiation doses above study (Kalińczuk et al. 2016), it is relatively low yet still higher than the authors’ patient skin dose of 68.12 mGy (Mori et al. 2021) due to longer procedure time.

We think that time and radiation dose should be a major concern, especially when dealing with fragile pediatric patients. Advanced search in PubMed reveals a few case reports in neonates and only two case reports in pediatric cancer patients with venous catheter migration (Elgehiny et al. 2020; Eryilmaz et al. 2012). Neither duration of the procedure nor radiation doses were emphasized in these reports. Since no guideline exists about the dose concerns during such procedures, the principle of ‘ALARA’ should be implemented in all cases. Although the success of such procedures is quite high, it would be better not to use the trial and error method by trying many different materials which increases the procedure time. After diagnosing an embedded or inaccessible catheter tip, the best strategy should be executed using the appropriate technique.

The datasets used during the current study are available from the corresponding author on reasonable request.

Cheng CC, Tsai TN, Yang CC, Han CL (2009) Percutaneous retrieval of dislodged totally implantable central venous access system in 92 cases: experience in a single hospital. Eur J Radiol 69(2):346–350. https://doi.org/10.1016/j.ejrad.2007.09.034 Epub 2007 Oct 31. PMID: 17976941
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Elgehiny A, Ghanem K, Bou Hussein H, Ahmed M, Abohelwa M, Aboelella M, Mohamed M, Bitar F, Abboud M, Akel S, Al-Kutoubi A, Fakhri G, Arabi M (2020) Port-a-Cath fracture and migration in paediatric cancer patients: incidence and management at a tertiary care centre - a 15-year experience. Cardiol Young 30(7):986–990. https://doi.org/10.1017/S1047951120001390 Epub 2020 Jun 22. PMID: 32624075
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Eryilmaz E, Canpolat C, Celiker A (2012) Catheter fragment embolization: a rare yet serious complication of catheter use in pediatric oncology. Turk J Pediatr 54(3):294–297 PMID: 23094542
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Kalińczuk Ł, Chmielak Z, Dębski A, Kępka C, Rudziński PN, Bujak S, Skwarek M, Kurowski A, Dzielińska Z, Demkow M (2016) Percutaneous retrieval of centrally embolized fragments of central venous access devices or knotted Swan-Ganz catheters. Clinical report of 14 retrievals with detailed angiographic analysis and review of procedural aspects. Postepy Kardiol Interwencyjnej 12(2):140–155. https://doi.org/10.5114/aic.2016.59365 Epub 2016 May 11. PMID: 27279874; PMCID: PMC4882387
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Mori K, Somagawa C, Kagaya S, Sakai M, Homma S, Nakajima T (2021) “Pigtail through snare” technique: an easy and fast way to retrieve a catheter fragment with inaccessible ends. CVIR Endovasc 4(1):24. https://doi.org/10.1186/s42155-021-00218-6 PMID: 33651249; PMCID: PMC7925774
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This study was not supported by any funding.

Affiliations

Anadolu Medical Center Hospital affilliated with John’s Hopkin, Cumhuriyet M. 2255 S. No 3, 41400, Gebze, Kocaeli, Turkey
Murat Dökdök

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Murat DökdökView author publications
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Contributions

This study was designed and written by the author who performed the procedure. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Murat Dökdök.

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required in author’s institution; yet, routine informed consent was obtained from individual participant included in the study.

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Consent for publication was obtained for individual person’s data from parent/legal guardian using routine institutional consent form.

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Dökdök, M. Retrieval of a dislodged porth catheter with inaccessible tips in a pediatric cancer patient. CVIR Endovasc 4, 54 (2021). https://doi.org/10.1186/s42155-021-00241-7

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Received: 14 May 2021
Accepted: 01 June 2021
Published: 15 June 2021
DOI: https://doi.org/10.1186/s42155-021-00241-7

中文翻译：

在儿科癌症患者中取出带有无法接近的尖端的移出的 porth 导管

致编辑，

我们饶有兴趣地阅读了题为“通过圈套技术的尾纤：取出末端无法触及的导管碎片的简单快捷的方法”的文章。在这里，作者描述了一种改进的技术，将导管片段与通过圈套环推进的猪尾导管挂钩，以迅速取回末端无法触及的导管片段（Mori 等人，2021 年）。几十年来，介入放射科医生主要使用两种方法成功取回脱落的静脉导管碎片：圈套器或抓钳。此外，文献中还描述了其他改进的带有导管和导线的辅助方法。据我们所知，当导管没有游离端时，使用位于最佳位置的猪尾导管是由 Cheng 等人首次描述的。(2009)。

还有一些其他的单中心经验，包括文献中相对较小的病例系列；他们大多专注于材料和并发症；只有一个报告了透视时间和辐射剂量（Kalińczuk 等人，2016 年）。在这项研究中，报告的中位透视时间为 6.1 分钟（0.47-42.0），而最长手术入口皮肤暴露的最大剂量为 912 mGy。然而，没有给出与导管碎片尖端可及性相关的具体数据。最近，我们在一名接受髓母细胞瘤治疗的 8 岁女孩身上取出了一根拔出的静脉端口导管，该导管的尖端难以接近。静脉造影显示右颈内静脉壁有一个嵌入的近端导管尖端，右心室壁有一个难以接近的远端导管尖端，没有任何自由运动。与作者类似，我们使用 5 Fr 尾纤导管和 0.035 英寸电线连接端口导管的中央部分。然后用 20 cm Amplatz GooseNeck Snare (Medtronic, USA) 通过 6F 导管腔将硅端口导管从下腔静脉中取出。使用准直器将透视时间（57 分钟）、空气比释动能保持在相对较低的水平（734 mGy）。与上述研究的辐射剂量（Kalińczuk 等人，2016 年）相比，由于手术时间较长，它相对较低，但仍高于作者的患者皮肤剂量 68.12 mGy（Mori 等人，2021 年）。使用准直器将透视时间（57 分钟）、空气比释动能保持在相对较低的水平（734 mGy）。与上述研究的辐射剂量（Kalińczuk 等人，2016 年）相比，由于手术时间较长，它相对较低，但仍高于作者的患者皮肤剂量 68.12 mGy（Mori 等人，2021 年）。使用准直器将透视时间（57 分钟）、空气比释动能保持在相对较低的水平（734 mGy）。与上述研究的辐射剂量（Kalińczuk 等人，2016 年）相比，由于手术时间较长，它相对较低，但仍高于作者的患者皮肤剂量 68.12 mGy（Mori 等人，2021 年）。

我们认为时间和辐射剂量应该是一个主要问题，尤其是在处理脆弱的儿科患者时。PubMed 中的高级搜索显示了一些新生儿病例报告，只有两例儿童癌症患者静脉导管移位的病例报告（Elgehiny 等人，2020 年；Eryilmaz 等人，2012 年）。在这些报告中既没有强调手术的持续时间也没有强调辐射剂量。由于在此类程序中没有关于剂量问题的指南，因此应在所有情况下实施“ALARA”原则。尽管此类程序的成功率相当高，但最好不要通过尝试多种不同材料来使用反复试验方法，这会增加程序时间。在诊断出嵌入或无法接近的导管尖端后，应使用适当的技术执行最佳策略。

当前研究中使用的数据集可根据合理要求从相应的作者处获得。

Cheng CC, Tsai TN, Yang CC, Han CL (2009) 经皮取出完全植入式中心静脉通路系统 92 例：单院经验。Eur J Radiol 69(2):346–350。https://doi.org/10.1016/j.ejrad.2007.09.034 Epub 2007 年 10 月 31 日。PMID：17976941
文章 PubMed Google Scholar
Elgehiny A、Ghanem K、Bou Hussein H、Ahmed M、Abohelwa M、Aboelella M、Mohamed M、Bitar F、Abboud M、Akel S、Al-Kutoubi A、Fakhri G、Arabi M（2020）Port-a-Cath 骨折和儿童癌症患者的迁移：三级医疗中心的发病率和管理 - 15 年的经验。Cardiol Young 30(7):986–990。https://doi.org/10.1017/S1047951120001390 Epub 2020 年 6 月 22 日。PMID：32624075
文章 PubMed Google Scholar
Eryilmaz E、Canpolat C、Celiker A (2012) 导管碎片栓塞：一种罕见但严重的儿科肿瘤导管使用并发症。Turk J Pediatr 54(3):294–297 PMID: 23094542
考研谷歌学者
Kalińczuk Ł、Chmielak Z、Dębski A、Kępka C、Rudziński PN、Bujak S、Skwarek M、Kurowski A、Dzielińska Z、Demkow M (2016) 经皮取出中央静脉通路装置或打结的 Swan 中心栓塞碎片。14 次检索的临床报告，包括详细的血管造影分析和程序方面的审查。Postepy Kardiol Interwencyjnej 12(2):140–155。https://doi.org/10.5114/aic.2016.59365 Epub 2016 年 5 月 11 日。PMID：27279874；PMCID：PMC4882387
文章 PubMed PubMed Central Google Scholar
Mori K、Somagawa C、Kagaya S、Sakai M、Homma S、Nakajima T（2021 年）“通过圈套器的辫子”技术：一种简单快速的方法来检索末端难以触及的导管碎片。CVIR Endovasc 4(1):24。https://doi.org/10.1186/s42155-021-00218-6 PMID：33651249；PMCID：PMC7925774
文章 PubMed PubMed Central Google Scholar

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阿纳多卢医疗中心医院隶属于约翰霍普金大学，Cumhuriyet M. 2255 S. No 3, 41400, Gebze, Kocaeli, Turkey
Murat Dökdök

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