Intervention of rarely seen catheter loss during permanent tunneled hemodialysis catheterization: A case report

In patients with end-stage renal disease (ESRD), permanent hemodialysis catheters are often used by performing percutaneous catheterization to create a permanent vascular access. To the best of our knowledge, no cases with accidental loss of catheter piece during hemodialysis catheter replacement or during its retrieval under scopy has been reported in the literature yet. Case report: It was decided to retrieve the right permanent dialysis catheter of a 54-year-old woman, who had received a temporary dialysis catheter due to the development of catheter site infection in her 3rd permanent catheter (the first two were changed due to thrombosis). Due to excess adhesion in the region, the retrieval of the catheter was complicated, only half of it (proximal piece after cutting into two) was removed, while the distal section slipped and migrated to the right subclavian vein, up to the right atrium. The diagnosis was confirmed by chest radiographs showing that the distal piece of the catheter piece was in the right subclavian vein and right atrium. The catheter piece was retrieved through a minor invasive procedure made possible by scopy without any further complications. Conclusion: Permanent dialysis catheters should ideally be placed under scopy. Also, when the retrieval of a catheter is planned, cutting from any part of the catheter should never be performed.