Clinical Images

Difficult Retrieval of a Broken Catheter From a Total Implantable Venous Access Device

James J. Chen, MBBS;  Justin Y. Teng, MBBS, FRACP;  Sharad V. Shetty, MBBS, MD, FRACP

James J. Chen, MBBS;  Justin Y. Teng, MBBS, FRACP;  Sharad V. Shetty, MBBS, MD, FRACP

J INVASIVE CARDIOL 2018;30(7):E55-E56.

Key words: TIVAD, EN Snare device, endovascular retrieval, complications

An 84-year-old man presented with acute-onset central dull chest pain. He had colorectal cancer managed with surgical resection. Adjuvant chemotherapy was administered through a total implantable venous access device (TIVAD) (Groshong PowerPort; Bard) inserted without complication in 2011 through the right jugular vein. 

The patient was hemodynamically stable on arrival. Electrocardiography demonstrated sinus rhythm with Q waves in the anterior leads without reciprocal changes, and serial troponin levels were unremarkable. Chest x-ray revealed a broken segment of the TIVAD catheter lodged within the right ventricle. The subsequent successful attempt to remove the broken catheter is detailed in Figures 1A-1D. 

TIVAD catheter fractures are a rare phenomenon, with a fracture rate of 1.69% for TIVAD inserted via right internal jugular vein. Risk factors for catheter fracture include subclavian approach and intravenous ports with rigid locking nuts as compared to the catheter. Our experience suggests that use of a pigtail and pulling technique should be considered for the retrieval of fractured catheter segment if both ends are inaccessible for snaring.

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From the Department of Cardiology, Fiona Stanley Hospital, Perth, Australia. 

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted March 16, 2018. 

Address for correspondence: James Chen, MBBS, Department of Cardiology, Fiona Stanley Hospital, Locked Bag 100, Palmyra DC, Perth, Western Australia 6961. Email: