A knotted central venous catheter discovered at removal: when resistance should prompt imaging, not traction

Tina Tomić Mahečić; Anđela Babić; Igor  Balenović; Dora Karmelić; Lucija Biličić; Antonia Vukšić; Ivana Janja Bošnjak; Robert Baronica; Andrea Crkvenac Gregorek

Authors

Tina Tomić Mahečić Department of Anesthesiology and ICU, Universtiy Hospital Centre Zagreb, https://ror.org/00r9vb833 Author https://orcid.org/0000-0003-2470-6238
Anđela Babić Policlinic Duduković Kisić, Zagreb Author https://orcid.org/0009-0005-6530-0762
Igor Balenović Department of Anesthesiology and ICU, Universtiy Hospital Centre Zagreb, https://ror.org/00r9vb833 Author https://orcid.org/0009-0001-6897-5299
Dora Karmelić Department of Anesthesiology and ICU, Universtiy Hospital Centre Zagreb, https://ror.org/00r9vb833 Author https://orcid.org/0000-0003-2328-7764
Lucija Biličić Department of Anesthesiology and ICU, Universtiy Hospital Centre Zagreb, https://ror.org/00r9vb833 Author
Antonia Vukšić Department of Anesthesiology and ICU, Universtiy Hospital Centre Zagreb, https://ror.org/00r9vb833 Author https://orcid.org/0000-0003-0663-3434
Ivana Janja Bošnjak Department of Anesthesiology and ICU, Universtiy Hospital Centre Zagreb, https://ror.org/00r9vb833 Author https://orcid.org/0009-0000-3089-8964
Robert Baronica Department of Anesthesiology and ICU, Universtiy Hospital Centre Zagreb, https://ror.org/00r9vb833 Author https://orcid.org/0009-0009-0840-5233
Andrea Crkvenac Gregorek Department of Surgery, https://ror.org/00r9vb833 Author https://orcid.org/0000-0002-7790-1347

Keywords:

Central Venous Catheter, Complications, knot

Abstract

Dear Editor,
Central venous catheter (CVC) placement is routine in acute care, yet mechanical complications remain clinically important. Most attention rightly focuses on arterial puncture, pneumothorax, infection, and thrombosis. Knot formation at the distal end of a standard multilumen CVC is uncommon and easily missed when the line functions normally during use.
We wish to report a case that illustrates this hazard.
We hope this report encourages colleagues to stop, image, and seek specialist input when catheter removal
is unexpectedly difficult.

References

1. Erkılıç E, Aksoy M, Gümüş T, Sarı S, Kesimci E. Jugular Venous Catheterization: A Case of Knotting. Case Rep Med. 2015;2015:810346. doi: 10.1155/2015/810346. Epub 2015 Nov 8. PMID: 26633975; PMCID: PMC4655031.

2. Hayaran N, Goyal N, Joy S, Jain A. Coiling of Central Venous Catheter: A Rare and Preventable Complication. Anesth Essays Res. 2017 Jul-Sep;11(3):773-775. doi: 10.4103/aer.AER_47_17. PMID: 28928586; PMCID: PMC5594805.

3. Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF. Mechanical complications of central venous catheters. J Intensive Care Med. 2006 Jan-Feb;21(1):40-6. doi: 10.1177/0885066605280884. PMID: 16698743.

4. Teja B, Bosch NA, Diep C, et al. Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis. JAMA Intern Med. 2024;184(5):474–482. doi:10.1001/jamainternmed.2023.8232

5. Urevick AJ, Briscoe WE, Harpstead E, Koontz CS, Bhattacharya SD. Use of a Guide-wire as an Adjunct for the Safe Removal of a 'Stuck' Indwelling Central Venous Catheter at Risk for Breaking. Am Surg. 2023 Sep;89(9):3898-3899. doi: 10.1177/00031348231173969. Epub 2023 May 11. PMID: 37165956.

A knotted central venous catheter discovered at removal: when resistance should prompt imaging, not traction

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