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Clin. Cardiol. 24, 89 (2001)
This section edited by Edward A. Geiser, M.D.
Vincent S. DeGeare, M.D., and Robert D. Safian, M.D.*
Department of Cardiology/MCHE-MDC, Brooke Army Medical Center, Ft. Sam Houston, Texas; and *Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
An 82-year-old male with a history of osteomyelitis was seen for fever, chills, and recurrent pain and erythema in his left foot. The patient had undergone placement of a peripherally inserted central catheter (PICC line) approximately 3 months prior and had been scheduled to receive a 6-week course of intravenous antibiotics. While at a convalescence home he inadvertently removed the line and therefore his antibiotic course was completed intramuscularly. A routine chest x-ray revealed a long segment of catheter in the pulmonary circulation straddling both the right and left pulmonary arteries. This was easily imaged in the anteroposterior projection (Fig. 1). To further complicate matters, the patient was status-post DDD pacemaker placement and had two atrial leads and a ventricular lead in place. He was referred to our institution for percutaneous removal of the catheter remnant.
Fig. 1 Anteroposterior projection showing a long segment of PICC line in the pulmonary circulation (arrows).
Removal of the foreign body was accomplished via the right femoral vein. An 8-French multipurpose catheter was advanced into the right pulmonary artery. A 6-French pigtail catheter was advanced through the multipurpose catheter and used to hook the PICC line remnant and pull it into the right atrium. Fortunately, the distal marker of the PICC line was then visible in the superior vena cava (SVC). The multipurpose catheter was directed into the SVC and the PICC line was then snared using a 0.018" Retriever (Boston Scientific/Target, Fremont, Calif., USA) endovascular snare and withdrawn through the femoral sheath (Fig. 2). Fluoroscopy at the end of the procedure revealed no displacement of the pacemaker leads and follow-up pacemaker interrogation revealed no change in capture or sensing thresholds.
Fig. 2 PICC line remnant measuring 50.0 cm in length.**
Reference