Sir,
External jugular vein (EJV) is commonly used for venous manometer and catheterization when peripheral venous assess is difficult. Though central venous assess is the preferred method in emergency setting, sometimes, EJV is cannulated with 16G or 18G intravenous cannula and secured in place with the help of sterile dressing and a 3-way stopcock attached to prevent air migration. Catheter fracture and embolization is a rarely reported complication of central venous and peripherally inserted central venous cannula.[1,2] We report the first instance of intravenous cannula fracture in our institute placed in EJV and distal migration toward clavicle.
Our patient is a 65-year-old female admitted in the Intensive Care Unit (ICU) and was inserted 18G cannula in the left EJV due to difficulty in obtaining peripheral venous assess and was to be removed by staff nurse at the time of patient discharge. During its removal, the catheter broke at its hub and it remained within the vein which was palpable. Due to late hours, exploration was planned the next day. There was gradual distal migration of the segment due to patient movement. Ultrasound could not detect the fractured segment. Computed tomography scan was done in which the fracture segment was visible in supraclavicular region at medial third of left clavicle [Figures 1 and 2]. The fractured segment was removed at the junction of thrombosed EJV and subclavian vein by surgical intervention (there was no interventional radiologist).[3,4]
Figure 1.
Sagittal section showing position of foreign body (fractured canula) in relation to clavicle
Figure 2.
Axial section showing foreign body in relation to clavicle
Rupture and distal migration of intravenous cannula can occur when there is prolonged catheterization, poor quality of intravenous cannula, and Not careful while removing catheter. Health-care workers in ward, ICU, and emergency department should be aware of the complications of intravenous cannula fracture and migration. Proper care should be taken during removal of catheters placed in central veins to avoid potentially serious complication of catheter migration and, if occurs, immediate steps have to be taken.
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Conflicts of interest
There are no conflicts of interest.
References
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