Double pigtail catheter reduction for seriously displaced intravenous infusion port catheter:A case report

BACKGROUND Implanted intravenous infusion port(TIAP)is mainly used for patients who need central venous infusion and poor peripheral vascular conditions.With the advantages of easy to carry,long maintenance cycle,few complications and excellent quality of life,it has been widely used in the fields of malignant tumor chemotherapy,parenteral nutrition support and repeated blood collection.Implanted intravenous infusion port(IVAP)dislocation can have significant complications if not recognised and reinstated immediately.CASE SUMMARY A 24-year-old man was treated with adjuvant chemotherapy for osteosarcoma.Severe displacement of IVAP catheter was found by chest X-ray examination.The IVAP cannot be used normally.Therefore,we conducted an emergency procedure to reset the catheter through double pigtail catheters,the operation was successful and the infusion port was restored.CONCLUSION When IVAP catheter displacement cannot be reset by conventional techniques,two pigtail catheters can be successfully used instead.

Removal of"ruptured"pulmonary artery infusion port catheter by pigtail catheter combined with gooseneck trap:A case report

BACKGROUND Implanted intravenous infusion port(IVAP)is indicated for patients undergoing chemotherapy,total parenteral nutrition and long-term antibiotic treatment.Among their complications,the rupture and migration of the catheter of an IVAP via internal jugular vein represents a very rare but potentially severe condition.CASE SUMMARY A 43-year-old woman was identified with a spontaneous fracture and migration of catheter of an IVAP via right internal jugular vein after adjuvant chemotherapy for left breast cancer.A computed tomography showed the fractured catheter of the IVAP in the pulmonary artery.Therefore,we conducted an emergency procedure to remove the catheter fragment by a pigtail catheter combined with a gooseneck trap.CONCLUSION When the fractured catheter of an IVAP was detected,the special shape of the pigtail catheter in combination with the gooseneck trap successfully facilitated the removal of the dislodged catheter.

Pleural effusion in critically ill patients and intensive care setting

Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.

Rescue of a patient with a 50 cm broken PICC tube retracted and wrapped in pulmonary artery:a case report

Objective:With the increasing use of a peripherally inserted central catheter(PICC)in clinical application,the breaking of the PICC is increasing as well,which would turn into the emboli and drift to the heart and pulmonary artery,causing severe consequences.However,few cases have been reported on the rescue of patients with a broken PICC.Patient concerns:A 33-year-old man,diagnosed with chronic hepatitis B-related decompensated cirrhosis and cryptococcal meningitis,was treated with amphotericin B combined with flucytosine and fluconazole by means of PICC catheterization.The patient was discharged with a catheter;when he returned for re-examination,a 50cm length of PICC broke and slipped into the vein after his sudden dysphoria.First aid was immediately administered,and then the intervention therapy to extricate the tube,including pulmonary artery angiography and intravascular removal of foreign matter,was performed based on the consensus of the in-hospital vein treatment group.At last,the broken PICC fragment was successfully taken out of the vessel.Re-examination after surgery showed that he recovered well.Conclusions:Once the catheter is broken,the X-ray examination should be performed at the first instance and re-examined frequently.Moreover,the involvement of a multidisciplinary team should be formed to decide the appropriate method of treatment to ensure a successful rescue.