Entrapment of a subclavian venous catheter in a child--how to get it out?

OBJECTIVE

To report a rare case of an entrapped subclavian venous catheter and to describe an anatomically based maneuver to remove it.

DESIGN

Case report.

SETTING

Pediatric critical care unit in a tertiary care hospital.

PATIENT: An 8-yr-old girl suffering from 50% body surface area burns and clinical sepsis in whom a double lumen subclavian venous catheter, placed 12 days earlier, could not be removed.

INTERVENTION: Concomitant abduction and internal rotation of the shoulder and outward traction in the scapular plane plus backward pressure on the first rib while carefully pulling out the entrapped catheter.

RESULT: Successful removal of the intact catheter, avoiding catheter disruption and embolization.

CONCLUSION

Side hole of an acutely placed multilumen catheter may be entrapped at the costoclavicular angle. An anatomically-based maneuver may widen the gap between the clavicle and the first rib and enable safe removal of the catheter.