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Removal of an Embolized Polyethylene Catheter Using a Ureteral Stone Catheter
CARDIOVASCULAR TECHNIQUES
Removal of an Embolized Polyethylene Catheter Using a Ureteral Stone Catheter*
David Shander, M.D.··
Foreign bodies lodged within the heart or major vessels have usually required thoracotomy for their removal. 1 ,2 Lassers and Pickering' described
vice for the removal of an embolized polyethylene catheter from the superior vena cava.
For editorial comment, see page 307
A 60-year-old woman was admitted to the hospital for insertion of an aortic bifurcation graft. Postoperatively an indwelling polyethylene catheter 20 em in length was in-
the successful removal of a broken piece of guide wire from the aorta by using a ureteral catheter with a retractable wire basket on the end. The present report describes the use of this same de·From the Cardiology Division~ University of Colorado Medical Center, Denver, Coloraao. ··Fellow in Cardiology.
FIGURE 1. Chest x-ray film showing polyethylene catheter lodged in apex of right ventricle with proximal end in superior vena cava (a"ow).
FIGURE 2. Distal end of Donnia catheter showing basket in open position encasing proximal end of polyethylene catheter.
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REMOVAL OF EMBOLIZED POLYETHYLENE CATHETER selted into the left external jugular vein for purposes of intravenous infusions. On the third postoperative day, while Inaniplllating the partially clogged catheter, it came loose fronl the metal adaptor and disappeared into the puncture site. A chest film revealed it to have lodged in the right ventricle with the proximal end in the superior vena cava (Fig 1). The patient was taken to the cardiac catheterization laboratory where the right external jugular vein was exposed and a 60 em ureteral catheter with a retracting wire basket (Dormia stone catheter)O (Fig 2) was advanced into the superior vena cava. The tip was advanced to just above the polyethylene catheter, and the basket fully extended. The catheter was then cautiously advanced another centimeter past the polyethylene catheter and the basket retracted, snaring the embolized catheter, which was then easily withdrawn through the vein. Elapsed fluoroscopy time was three minutes. DISCUSSION
Massumi and Ross4 were able to extract a fragment of polyethylene catheter from the superior vena cava using a snare device consisting of a large piece of polyethylene tubing through which a loop of flexible guide wire was inserted to remove the foreign body. The Dormia catheter, or ureteric stone catheter, used in this case, seems unusually well suited for retrieving foreign bodies lying entirely, or partly within a vessel. The diameter of the soft wire basket when extended, occupies much of the cross-sectional area of even the largest vessels and when advanced over the end of an embolized catheter fragment, is very likely to engulf
°v. Mueller Inc., Chicago, Illinois
it. The spiral configuration of the struts makes entrapment of a linear object relatively simple, and provided the catheter has been introduced through a relatively large vessel, such as an external jugular vein, removal is easily effected even if the polyethylene tube doubles over on retracting it. Recently, we have successfully extracted another polyethylene catheter fragment, using the same technique, from another patient under similar circumstances. SUMMARY
Removal of an embolized polyethylene catheter from the superior vena cava through use of a ureteric catheter with a retractable wire basket on the end is described. This device seems unusually well suited to retrieving embolized catheter fragments. REFERENCES
1 DoERING, R.B., STEM~fER, E.A., AND CONNOLLY, J.E.: Complications of indwelling venous catheters, with particular reference to catheter embolus, Amer. ]. Surg., 114:259,1967. 2 WELLl\-IANN, K.F., REINHARD, A., AND SALAZAR, E.P.: Polyethylene catheter embolism: review of the literature and report of a case with associated fatal tricuspid and systemic candidiasis, Circulation, 37:380, 1968. 3 LASSERS, B.W., AND PICKERING, D.: Removal of an iatrogenic foreign body from the aorta by means of a ureteric stone catcher, Amer. Heart ]., 73:375, 1967. 4 MAssmu, R.A., AND Ross, A.M.: Atraumatic, nonsurgical technique for removal of broken catheters from cardiac cavities, New Eng. ]. Med., 277:195, 1967.
PHILOSOPHER EMPEROR Marcus Aurelius (121-180) is the last of the Stoic sages. He was an efficient ruler. His book of MEDITATIONS is a work which the world has cherished. It has a message for mankind, and it can be summed up in a word, resignation. We should resign ourselves to the fact that men come and men go, and that after death, as Seneca said, we are either happy or nonexistent. He emphasizes the transiency of life, but he
CHEST, VOL. 57, NO.4, APRIL 1970
does not follow it with the advice to rush therefore into a round of pleasure. The duty of resignation is not that of an unfeeling soul but of an extremely human person, one who accepts things as they are and who is, in his words, kindly affected toward men. Ba~es, H. E.: Intellectual and Cultural History of the Western World (3rd 00.), Dover, New York, 1965
Removal of an Embolized Polyethylene Catheter Using a Ureteral Stone Catheter*
David Shander, M.D.··
Foreign bodies lodged within the heart or major vessels have usually required thoracotomy for their removal. 1 ,2 Lassers and Pickering' described
vice for the removal of an embolized polyethylene catheter from the superior vena cava.
For editorial comment, see page 307
A 60-year-old woman was admitted to the hospital for insertion of an aortic bifurcation graft. Postoperatively an indwelling polyethylene catheter 20 em in length was in-
the successful removal of a broken piece of guide wire from the aorta by using a ureteral catheter with a retractable wire basket on the end. The present report describes the use of this same de·From the Cardiology Division~ University of Colorado Medical Center, Denver, Coloraao. ··Fellow in Cardiology.
FIGURE 1. Chest x-ray film showing polyethylene catheter lodged in apex of right ventricle with proximal end in superior vena cava (a"ow).
FIGURE 2. Distal end of Donnia catheter showing basket in open position encasing proximal end of polyethylene catheter.
348
349
REMOVAL OF EMBOLIZED POLYETHYLENE CATHETER selted into the left external jugular vein for purposes of intravenous infusions. On the third postoperative day, while Inaniplllating the partially clogged catheter, it came loose fronl the metal adaptor and disappeared into the puncture site. A chest film revealed it to have lodged in the right ventricle with the proximal end in the superior vena cava (Fig 1). The patient was taken to the cardiac catheterization laboratory where the right external jugular vein was exposed and a 60 em ureteral catheter with a retracting wire basket (Dormia stone catheter)O (Fig 2) was advanced into the superior vena cava. The tip was advanced to just above the polyethylene catheter, and the basket fully extended. The catheter was then cautiously advanced another centimeter past the polyethylene catheter and the basket retracted, snaring the embolized catheter, which was then easily withdrawn through the vein. Elapsed fluoroscopy time was three minutes. DISCUSSION
Massumi and Ross4 were able to extract a fragment of polyethylene catheter from the superior vena cava using a snare device consisting of a large piece of polyethylene tubing through which a loop of flexible guide wire was inserted to remove the foreign body. The Dormia catheter, or ureteric stone catheter, used in this case, seems unusually well suited for retrieving foreign bodies lying entirely, or partly within a vessel. The diameter of the soft wire basket when extended, occupies much of the cross-sectional area of even the largest vessels and when advanced over the end of an embolized catheter fragment, is very likely to engulf
°v. Mueller Inc., Chicago, Illinois
it. The spiral configuration of the struts makes entrapment of a linear object relatively simple, and provided the catheter has been introduced through a relatively large vessel, such as an external jugular vein, removal is easily effected even if the polyethylene tube doubles over on retracting it. Recently, we have successfully extracted another polyethylene catheter fragment, using the same technique, from another patient under similar circumstances. SUMMARY
Removal of an embolized polyethylene catheter from the superior vena cava through use of a ureteric catheter with a retractable wire basket on the end is described. This device seems unusually well suited to retrieving embolized catheter fragments. REFERENCES
1 DoERING, R.B., STEM~fER, E.A., AND CONNOLLY, J.E.: Complications of indwelling venous catheters, with particular reference to catheter embolus, Amer. ]. Surg., 114:259,1967. 2 WELLl\-IANN, K.F., REINHARD, A., AND SALAZAR, E.P.: Polyethylene catheter embolism: review of the literature and report of a case with associated fatal tricuspid and systemic candidiasis, Circulation, 37:380, 1968. 3 LASSERS, B.W., AND PICKERING, D.: Removal of an iatrogenic foreign body from the aorta by means of a ureteric stone catcher, Amer. Heart ]., 73:375, 1967. 4 MAssmu, R.A., AND Ross, A.M.: Atraumatic, nonsurgical technique for removal of broken catheters from cardiac cavities, New Eng. ]. Med., 277:195, 1967.
PHILOSOPHER EMPEROR Marcus Aurelius (121-180) is the last of the Stoic sages. He was an efficient ruler. His book of MEDITATIONS is a work which the world has cherished. It has a message for mankind, and it can be summed up in a word, resignation. We should resign ourselves to the fact that men come and men go, and that after death, as Seneca said, we are either happy or nonexistent. He emphasizes the transiency of life, but he
CHEST, VOL. 57, NO.4, APRIL 1970
does not follow it with the advice to rush therefore into a round of pleasure. The duty of resignation is not that of an unfeeling soul but of an extremely human person, one who accepts things as they are and who is, in his words, kindly affected toward men. Ba~es, H. E.: Intellectual and Cultural History of the Western World (3rd 00.), Dover, New York, 1965