Removal of the Retained Ventricular Catheter Using the Endoscopic Monopolar Instrument

Background. Ventriculoperitoneal shunt (VPS) remains the main treatment for hydrocephalus. However, VPS revision surgery is very common. Here, we present a case in which the retained ventricular catheter was removed using the endoscopic monopolar instrument. Methods. We report a case of a 28-year-old female who presented with VPS obstruction. She had two previous shunt revision surgeries due to shunt obstruction. Eleven years after the last one, she presented an abdominal pseudocyst that indicated a total system removal. During VPS revision surgery, a retained ventricular catheter was observed. The endoscopic monopolar instrument was introduced into the retained catheter under direct view. Coagulations in a back-and-forth movement were applied to release inner catheter adhesions. After these steps, the catheter was removed, and a new one was placed through the same route. Results. The catheter was removed without complications, confirmed by the postoperative cranial computed tomography. The patient remained asymptomatic. Conclusion. The described technique was effective and avoided ventricular bleeding. Further studies are necessary to validate this method.

Incidental unintentional breakage of epidural catheter in supralaminar area: A case report

Background: Among some of the known complications, breakage of epidural catheter, though is extremely rare, is a well-established entity. Visualization of retained catheter is difficult even with current radiological imaging techniques, and active surgical intervention might be necessary for removal of catheter fragment. We report such a case of breakage of an epidural catheter during its insertion which led to surgical intervention. Case Description: A 52-year-old, an 18G radiopaque epidural catheter was inserted through an 18G Tuohy needle into the epidural space at T8-T9 interspace in left lateral position. Resistance was encountered. While the catheter was being removed with gentle traction along with Tuohy needle, it sheared off at 12 cm mark. After informing the operating surgeon and the patient, immediately an magnetic resonance imaging and computed tomography (CT) scan were done. CT scan with sagittal and coronal reconstruction was done. Epidural catheter was visualized at D9 lamina-spinous process junction who was removed by surgical intervention. Conclusion: Leaving of epidural catheter puts the anesthetist in a dilemma. To evade such an event, it is important to stick to the traditional guiding principle for epidural insertion and removal. In spite of safety measures, if event occurs, the patient should be informed about it. Surgery is reserved for symptomatic patients or asymptomatic patients to avoid future complications.

Retained Catheter in the Aorta

Due to the recent increase in endovascular procedures, retained foreign bodies such as stents and catheters in vasculature have become a common and serious complication. Treatments for these complications vary depending on the acuity and stability of the foreign body in the vessel. We discuss a rare case of an adult found to have an incidental retained umbilical artery catheter in the aorta.

If it looks like a catheter and winds like a catheter . . . fibroblastic sheath mimicking a central venous catheter fragment: A case report

Introduction: Fibroblastic sheath formation is a well-known complication of long-term central venous catheters. When calcified, fibroblastic (formerly known as “fibrin”) sheaths may be easily mistaken for retained catheter fragments. We describe one such case and how imaging was used to recognize the sheath and avoid unnecessary interventions. Case Description: A patient with systemic sclerosis was referred for port removal because of suspected infection. A later computed tomography scan showed a persistent tubular structure coursing behind the right clavicle, which was also seen in an anteroposterior chest radiograph. Three-dimensional reconstruction and analysis of the structure’s lumen in comparison to previous imaging studies allowed us to confirm that it was, in fact, a calcified fibroblastic sheath. The patient’s course was uneventful thereafter. Conclusion: Three-dimensional computed tomography reconstruction, as well as the hollow appearance of a tubular structure after removal of a central catheter may help differentiate a fibroblastic sheath from a retained catheter fragment. Accurate surgical notes mentioning the length of the catheter at implant and explant are also of paramount importance.

Chronically Retained Central Venous Catheter in Deceased Donor Liver Allograft

Central venous catheters (CVC) are commonly used across multiple medical specialties and are inserted for various reasons. A known, but rare, serious complication of CVC is fracture and retention of residual catheter. Here we describe a chronically retained catheter within the inferior vena cava (IVC) that was asymptomatic and neither diagnosed nor addressed until time of deceased donor liver donation. Prior to transplantation into the recipient, the retained catheter was removed, and a venoplasty of the suprahepatic IVC, middle hepatic vein, and left hepatic vein was performed with no significant issues after transplant in the recipient. With the persistent shortage of suitable organs for transplant leading to patients dying on the waiting list, every good quality organ should be carefully considered. Thus, even though a chronically retained, fractured CVC in a deceased organ donor presents a unique challenge, it can be managed surgically and should not be considered a contraindication to organ utilization.

Endoscopic Retrieval of Flanged Ventricular Catheters

Flanged ventricular catheters are now used infrequently. Many patients with longstanding hydrocephalus still harbor these catheters, either as their current ventricular catheter, or as a retained catheter from a prior implant. The removal of flanged ventricular catheters is sometimes necessary, and may be challenging due to intraventricular adhesions. We describe the use of an endoscopic technique for the successful retrieval of flanged ventricular catheters in two patients. The technique described in this report may be helpful for patients that have flanged ventricular catheters that must be removed.

Paraparesis after Lumbar Drain Placement and Catheter Tear: A Rare Case Report

Lumbar spinal drain placement is being done with increasing frequency either to reduce intracranial pressure or facilitate view of surgical field in neurosurgical procedures. Complications due to fracture of catheter and/or retained catheter are rare and underreported but are of concern. The management of such a complication, surgical or conservative, depends on location of retained fragment of catheter, patient condition, or resulting complications due to catheter shearing. In this case, the position of the retained catheter fragment does not explain the subsequent paraparesis, which resolved with conservative management. Since there are no guidelines to handle such cases, it is important to individualize patient management. Proper positioning, technique and expertise, and some changes in Tuohy needle tip are required to reduce complications due to broken spinal drains. This case report emphasizes on the measures that can be taken to prevent shearing of spinal catheter.