Journal of JCIC

Online edition: ISSN 2432–2342
JCIC学会事務局 JCIC学会事務局
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of JCIC 5(1): 9-13 (2020)


血管内に迷入した皮下植込み型中心静脈カテーテルに対する経皮的回収術Percutaneous removal of migrated implantable central venous catheter

1国立成育医療研究センター循環器科National Center for Child Health and Development, Department of Cardiology

2国立成育医療研究センター外科National Center for Child Health and Development, Department of Surgery

受付日:2020年6月2日Received: June 2, 2020
受理日:2020年8月18日Accepted: August 18, 2020
発行日:2020年9月30日Published: September 30, 2020

皮下植込み型ポートはポート部とカテーテルが離断しそのカテーテルが血管内に迷入し,経皮的回収を要することがある.今回は経皮的に回収した2例を報告し,同様の素材・サイズのカテーテルの回収手技を体外で行った.〈症例1〉 8歳男児.血友病Aのため4年前に留置した6.6 Fr中心静脈ポートと中心静脈カテーテルが離断し,カテーテルが肺動脈に迷入していた.スネアカテーテルを用い肺動脈内で先端を把持し,10Frシース内に引き込み回収した.〈症例2〉 5歳女児.神経芽腫のため1年前に留置した6.6 Fr中心静脈ポートと中心静脈カテーテルが離断し,カテーテルが鎖骨下静脈から右房内に迷入していた.右鎖骨下静脈内の端を把持しようとしたが把持できず,5Fr pigtailカテーテルで下大静脈に移動させた後に10Frシース内に回収した.〈体外での手技〉 11 Frシースでは抵抗なく回収可能であった.9Fr, 8 Frでは抵抗があるものの回収可能であったが7 Frでは回収出来なかった.

An implantable central venous catheter is widely used for long-term central venous access. Serious complications include spontaneous fracture and migration of the implanted port catheter, which necessitates intervention. ‹case 1› A 8-year-old boy with hemophilia A, who had undergone placement of a 6.6 Fr implantable central venous catheter 4 years before, complained swelling in his right chest during intravenous injection via the port. A chest X-ray showed the migration of the fractured catheter in the pulmonary artery. The fractured catheter was captured at its end in the left pulmonary artery using a snare catheter and retrieved inside a 10 Fr sheath introducer via a percutaneous transfemoral approach without any complications. ‹case 2› A 5-year-old girl with neuroblastoma underwent placement of an implantable a 6.6 Fr central venous catheter 1 year before. A chest X-ray and echocardiography showed the fractured catheter migrated into the right atrium from the right subclavian vein. The end of the fractured catheter in the right subclavian vein was unable to be captured. The fractured catheter was pushed into the inferior vena cava using a 5 Fr pigtail catheter, and retrieved inside a 10 Fr sheath introducer without any complications. ‹Extra corporeal trial› A 6.6 Fr central venous catheter could be easily retrieved inside an 11Fr sheath introducer. It was also possible to retrieve into a 9 Fr and an 8 Fr sheaths, although with more frictional resistance. The catheter was unable to be retrieved into a 7Fr sheath.

Key words: foreign body removal; Implantable Central Venous catheter; Catheter complication; Sheath introducer size

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