Surgical Explantation of Difficult Removal PICC Involving Intravascular Compound in a Child Case

Itaru Hosaka＊	Tomohiro Nakajima＊	Riko Umeta＊
Akihito Ohkawa＊	Naomi Yasuda＊	Tsuyoshi Shibata＊
Yutaka Iba＊	Nobuyoshi Kawaharada＊

(Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine＊, Sapporo, Japan)

The peripherally inserted central catheter （PICC） is widely used as a central venous catheter for both pediatric and adult patients. Fewer procedure-related complications have been reported than for conventional methods using the internal jugular, femoral, or subclavian veins for access. On the other hand, thrombosis and phlebitis are more common than in conventional methods, and sometimes the catheter cannot be removed by manual traction. In this study, a 13-year-old girl had received long-term sedation from a PICC due to neurodegenerative disease. The patient was referred to our department because of difficulty in manual drawing for removal of the PICC. A CT scan showed that the PICC was bent at the right axillary vein and there was a high-density area around it. Surgical treatment was chosen after a joint conference between the department of pediatrics and us to discuss the reliability and invasiveness of the several treatments. Under general anesthesia, an incision was made under the right subclavian bone, and her axillary vein was exposed. The lumen of the vein was filled with a white plaster-like compound, and the catheter itself was buried inside it. The compound was removed, and the bent PICC was straightened and removed from the puncture site. There is no other case for difficult removal of PICC in this form without calcification. We believe that surgical removal was effective in this case because of her vascular structure.

 

Jpn. J.Cardiovasc Surg. 51 : 118-122 （2022）

Keywords：difficult PICC removal ; intravascular foreign body ; surgical treatment