A multiinstitutional review of central venous line complications: retained intravascular fragments

Background: There have been many reports of complications of central venous lines in children but limited discussion of the specific problem of retained intravascular fragments after attempted removal. We report on a series of 6 patients from 2 tertiary pediatric hospitals that had intravascular segments of long-term central venous lines that could not be removed and so were left in situ. Methods: We conducted a retrospective multiinstitutional review of long-term central venous lines (Broviacs, Port-A-Caths, and Hickmans) removed in the operating room with a focused chart review and prospective follow-up of those patients that had a failed attempt at removal. Results: A total of 299 central venous lines were removed with 6 patients identified as having fragments of lines left behind (2%). The lines had been in place for an average of 37 ± 12 months. The average follow-up period is now 5.4 ± 3.9 years; none of the patients have developed any symptoms, evidence of thrombus, infection, or catheter migration. Conclusion: Given the 2% incidence rate, the issue of managing a stuck long-term central venous line will face most individuals who place these lines. We have demonstrated that simply ligating the catheter and leaving the fragment in place appears to be a safe option with minimal risk to the patient.