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Spontaneously migrated tip of an implantable port catheter into the axillary vein in a patient with severe cough and the subsequent intervention to reposition it.

Ahn KS, Yoo K, Cha IH, Seo TS - Korean J Radiol (2008)

Bottom Line: Migration of an implantable port catheter tip is one of the well-known complications of this procedure, but the etiology of this problem is not clear.We describe here a case of migration of the tip of a port catheter from the right atrium to the right axillary vein in a patient with severe cough.We corrected the position of the catheter tip via transfemoral snaring.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Korea University Guro Hospital, Seoul, Korea.

ABSTRACT
Migration of an implantable port catheter tip is one of the well-known complications of this procedure, but the etiology of this problem is not clear. We describe here a case of migration of the tip of a port catheter from the right atrium to the right axillary vein in a patient with severe cough. Coughing was suggested for this case as the cause of the catheter tip migration. We corrected the position of the catheter tip via transfemoral snaring.

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Migration of implantable port catheter in 64-year-old man.A. Implantable port catheter is inserted via jugular approach. Tip of catheter is well-placed in right atrium.B. Four days after implantation procedure, chest PA radiograph shows coiled catheter and migration of tip from right atrium to right axillary vein. Associated pulmonary edema, cardiomegaly, air space consolidation with volume loss in left lung and pleural thickening with effusion in left hemithorax are also noted.C. 5-Fr pigtail catheter is advanced to right subclavian vein to hook migrated port catheter.D. Gooseneck snare wire and cobra catheter were used to capture wire.E, F. After repositioning (E), catheter shows normal position and curve. However, when we induced patient to cough (F), bending of catheter toward subclavian vein (arrow) was found on fluoroscopy.G. Two days later, recurrent catheter migration was found on chest radiograph. Coiling is noted in middle of catheter, but catheter tip is still located in superior vena cava.
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Figure 1: Migration of implantable port catheter in 64-year-old man.A. Implantable port catheter is inserted via jugular approach. Tip of catheter is well-placed in right atrium.B. Four days after implantation procedure, chest PA radiograph shows coiled catheter and migration of tip from right atrium to right axillary vein. Associated pulmonary edema, cardiomegaly, air space consolidation with volume loss in left lung and pleural thickening with effusion in left hemithorax are also noted.C. 5-Fr pigtail catheter is advanced to right subclavian vein to hook migrated port catheter.D. Gooseneck snare wire and cobra catheter were used to capture wire.E, F. After repositioning (E), catheter shows normal position and curve. However, when we induced patient to cough (F), bending of catheter toward subclavian vein (arrow) was found on fluoroscopy.G. Two days later, recurrent catheter migration was found on chest radiograph. Coiling is noted in middle of catheter, but catheter tip is still located in superior vena cava.

Mentions: A 64-year-old man with squamous cell lung cancer (T4N2M0, stage IIIb) had an 8-Fr port device catheter (Healthport, Baxter Healthcare Co., McGaw Park, IL) implanted via the right jugular vein under radiologic intervention for administering his monthly chemotherapy. After the implantation, the catheter tip was well-placed at the right atrium, as was noted with on chest radiography with the patient in the supine position (Fig. 1A). Four days after the procedure, the chest posteroanterior radiograph showed migration of the catheter tip with coiling into the right axillary vein, but the location of the port was not changed (Fig. 1B). The patient was in a state of remission and he usually rested in bed without strenuous exercise, yet the patient had a severe cough during this period. On the next day, we tried to reposition the tip of the port catheter. Two punctures were made in the right femoral vein. A 5-Fr pigtail catheter (Boston Scientific, Natick, MA) was inserted, via the first puncture site, with a 0.035-inch guide wire (Terumo, Tokyo, Japan). The 5-Fr pigtail catheter was advanced to the right subclavian vein to hook the migrated catheter. The guide wire was directed backward to the inferior vena cava (IVC) (Fig. 1C). A gooseneck snare wire (C.R. Bard, Inc, Murray Hill, NJ) with a cobra catheter (Cook, Bloomington, IN) was inserted via the second puncture site and it was used to grasp the end of the guide wire in the suprarenal IVC (Fig. 1D). By simultaneous pulling of the wire loop, repositioning of the tip of the port catheter was successfully achieved and the tip was relocated at the initial position. The patient still had intermittent cough during the procedure and we observed lateral bending of the upper one third of the catheter to the right subclavian vein when the patient was coughing. After the reposition procedure, when we induced the patient to cough, we were able to again demonstrate this movement on fluoroscopy (Figs. 1E, F). This was very suggestive to have caused the catheter migration. Two days later, migration and coiling of the catheter were again demonstrated on the chest posteroanterior radiograph (Fig. 1G) in spite that there was no active physical movement by the patient. Because the tip of the catheter was still located in the superior vena cava and there was a considerable risk of remigration due to the patient's sustained cough, additional repositioning was not attempted thereafter. There was no additional positional change of the catheter seen on the serial follow up chest radiographs. Chemotherapy was delayed because the patient developed pneumonia. The port was used for administering central venous fluid and the function of the port catheter was preserved well. Sadly, about four weeks later, the patient expired due to aggravated pneumonia and respiratory failure.


Spontaneously migrated tip of an implantable port catheter into the axillary vein in a patient with severe cough and the subsequent intervention to reposition it.

Ahn KS, Yoo K, Cha IH, Seo TS - Korean J Radiol (2008)

Migration of implantable port catheter in 64-year-old man.A. Implantable port catheter is inserted via jugular approach. Tip of catheter is well-placed in right atrium.B. Four days after implantation procedure, chest PA radiograph shows coiled catheter and migration of tip from right atrium to right axillary vein. Associated pulmonary edema, cardiomegaly, air space consolidation with volume loss in left lung and pleural thickening with effusion in left hemithorax are also noted.C. 5-Fr pigtail catheter is advanced to right subclavian vein to hook migrated port catheter.D. Gooseneck snare wire and cobra catheter were used to capture wire.E, F. After repositioning (E), catheter shows normal position and curve. However, when we induced patient to cough (F), bending of catheter toward subclavian vein (arrow) was found on fluoroscopy.G. Two days later, recurrent catheter migration was found on chest radiograph. Coiling is noted in middle of catheter, but catheter tip is still located in superior vena cava.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627199&req=5

Figure 1: Migration of implantable port catheter in 64-year-old man.A. Implantable port catheter is inserted via jugular approach. Tip of catheter is well-placed in right atrium.B. Four days after implantation procedure, chest PA radiograph shows coiled catheter and migration of tip from right atrium to right axillary vein. Associated pulmonary edema, cardiomegaly, air space consolidation with volume loss in left lung and pleural thickening with effusion in left hemithorax are also noted.C. 5-Fr pigtail catheter is advanced to right subclavian vein to hook migrated port catheter.D. Gooseneck snare wire and cobra catheter were used to capture wire.E, F. After repositioning (E), catheter shows normal position and curve. However, when we induced patient to cough (F), bending of catheter toward subclavian vein (arrow) was found on fluoroscopy.G. Two days later, recurrent catheter migration was found on chest radiograph. Coiling is noted in middle of catheter, but catheter tip is still located in superior vena cava.
Mentions: A 64-year-old man with squamous cell lung cancer (T4N2M0, stage IIIb) had an 8-Fr port device catheter (Healthport, Baxter Healthcare Co., McGaw Park, IL) implanted via the right jugular vein under radiologic intervention for administering his monthly chemotherapy. After the implantation, the catheter tip was well-placed at the right atrium, as was noted with on chest radiography with the patient in the supine position (Fig. 1A). Four days after the procedure, the chest posteroanterior radiograph showed migration of the catheter tip with coiling into the right axillary vein, but the location of the port was not changed (Fig. 1B). The patient was in a state of remission and he usually rested in bed without strenuous exercise, yet the patient had a severe cough during this period. On the next day, we tried to reposition the tip of the port catheter. Two punctures were made in the right femoral vein. A 5-Fr pigtail catheter (Boston Scientific, Natick, MA) was inserted, via the first puncture site, with a 0.035-inch guide wire (Terumo, Tokyo, Japan). The 5-Fr pigtail catheter was advanced to the right subclavian vein to hook the migrated catheter. The guide wire was directed backward to the inferior vena cava (IVC) (Fig. 1C). A gooseneck snare wire (C.R. Bard, Inc, Murray Hill, NJ) with a cobra catheter (Cook, Bloomington, IN) was inserted via the second puncture site and it was used to grasp the end of the guide wire in the suprarenal IVC (Fig. 1D). By simultaneous pulling of the wire loop, repositioning of the tip of the port catheter was successfully achieved and the tip was relocated at the initial position. The patient still had intermittent cough during the procedure and we observed lateral bending of the upper one third of the catheter to the right subclavian vein when the patient was coughing. After the reposition procedure, when we induced the patient to cough, we were able to again demonstrate this movement on fluoroscopy (Figs. 1E, F). This was very suggestive to have caused the catheter migration. Two days later, migration and coiling of the catheter were again demonstrated on the chest posteroanterior radiograph (Fig. 1G) in spite that there was no active physical movement by the patient. Because the tip of the catheter was still located in the superior vena cava and there was a considerable risk of remigration due to the patient's sustained cough, additional repositioning was not attempted thereafter. There was no additional positional change of the catheter seen on the serial follow up chest radiographs. Chemotherapy was delayed because the patient developed pneumonia. The port was used for administering central venous fluid and the function of the port catheter was preserved well. Sadly, about four weeks later, the patient expired due to aggravated pneumonia and respiratory failure.

Bottom Line: Migration of an implantable port catheter tip is one of the well-known complications of this procedure, but the etiology of this problem is not clear.We describe here a case of migration of the tip of a port catheter from the right atrium to the right axillary vein in a patient with severe cough.We corrected the position of the catheter tip via transfemoral snaring.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Korea University Guro Hospital, Seoul, Korea.

ABSTRACT
Migration of an implantable port catheter tip is one of the well-known complications of this procedure, but the etiology of this problem is not clear. We describe here a case of migration of the tip of a port catheter from the right atrium to the right axillary vein in a patient with severe cough. Coughing was suggested for this case as the cause of the catheter tip migration. We corrected the position of the catheter tip via transfemoral snaring.

Show MeSH
Related in: MedlinePlus