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CC BY 4.0 · Surg J (N Y) 2020; 06(03): e153-e156
DOI: 10.1055/s-0040-1713415
Case Report

An Unexpected Case of Late Fatal Central Venous Catheter Sepsis: A Case Report

Rosanne Ottevanger 
1   Department of Surgery, Noordwest Ziekenhuisgroep, the Netherlands
,
Sverre A.I. Loggers
1   Department of Surgery, Noordwest Ziekenhuisgroep, the Netherlands
,
Unsal Yapici
2   Department of Pathology, Noordwest Ziekenhuisgroep, the Netherlands
,
Joost M.R. Meijer
3   Department of Intensive Care, Noordwest Ziekenhuisgroep, the Netherlands
,
Giel G. Koning
1   Department of Surgery, Noordwest Ziekenhuisgroep, the Netherlands
4   Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands
› Author Affiliations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Introduction Central venous catheters (CVC) are associated with risks and complications. Complications like vessel perforation, thrombosis, infection with significant morbidity and mortality, knotting, and ventricular perforation have been described. Another less-frequent complication is retained CVC fragments. We present a case of a very late but fatal complication after a CVC placement. This report is written in line with the consensus-based surgical case report guidelines (SCARE).

Case A 46-year-old male presented to the emergency department in a critical (septic) shock. The patients' medical history featured a long–intensive care admission 28 years ago. The cause of this sepsis was not evident until a computed tomography scan was performed to exclude a pulmonary embolism, revealing a remnant of a central catheter in both pulmonary arteries. Despite extensive resuscitation, the patient died within 24 hours after admission. An autopsy was performed confirming that the catheter remnant was the only possible cause of the fatal sepsis.

Discussion CVC's are associated with (fatal) complications; however, retainment of remnants are described unfrequently but do occur in almost 2% of the cases. Endovascular removal of these remnants has been performed successfully and should be the first treatment of choice if removal is considered. No evidence is available that suggests that routine removal has to be attempted but some longer term complications can be expected, so awareness of possible remnants after CVC removal should exist.

Conclusion Retained fragments of CVC's are rare but are described after prolonged use. This case shows that these retained intravascular fragments can cause fatal complications on the long-term. Upon removal of CVC's, there should be awareness that retainment of fragments can occur.

Keywords

central venous catheter - sepsis - endovascular - infectious catheter - complication - vascular


Publication History

Received: 13 June 2019

Accepted: 30 April 2020

Article published online:
10 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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