Always check the film: Retained central venous catheter fragment in a patient with intestinal failure

A 7-year-old male with a history of intestinal failure due to intestinal atresia dependent on parenteral nutrition via central venous catheter (CVC) presented to an outside institution for replacement of existing CVC due to thrombosis. Operative reports described the placement of a left internal jugular (IJ) 6.6-French single-lumen-tunneled CVC and removal of the existing right IJ-tunneled CVC. The report stated that the tip of the new CVC was confirmed to be located at the cavoatrial junction via fluoroscopy. A radiographic image was not available for our review and the fluoroscopic image was not read by a radiologist. Our institutional protocol recommends obtaining a chest radiograph to evaluate the CVC tip location every 1 year for children under 2 years of age, every 2 years for children over age 2 years, or following CVC placement/replacement. The chest radiograph obtained (Figure 1) noted the new left IJ CVC but also a large retained fragment of the prior right IJ CVC. The retained CVC fragment was then removed by an interventional radiologist by snare via the right common femoral vein access. There were no complications. Mechanical issues, including fracture, are common complications of CVCs.1 Specifically, retained CVC fragments after attempted removal have been described in the literature in pediatric patients with prolonged use of CVCs, with incidence ranging from 0.3% to 2%.2-4 Ongoing radiographic surveillance is recommended to assess the central location by ensuring the catheter tip resides at or near the cavoatrial junction.5 Clinicians caring for children with CVCs should familiarize themselves with the radiographic appearance of normally placed CVCs. Personally reviewing images, and avoiding relying only on operative, fluoroscopic, or radiology reports, to ensure the central location or integrity of the catheter can maximize the safety of long-term CVC use in this high-risk group. The authors declare no conflict of interest. Informed consent was obtained from the parents of the patient before manuscript submission. This report has not been previously presented or published.