Presentation
An intensive care patient with cardiac failure and seizure disorder. Multiple lines and tubes.
Patient Data
Portable X-rays demonstrate a fine, linear/ tubular density within the lateral and volar soft tissues of the distal forearm. This measured approximately 100 mm in length. The right wrist and hand are otherwise relatively unremarkable for the patient's advanced age.
The zoomed images with a modified (image 1) and a reverse window (image 2) demonstrate the linear tubular opacity much better.
There is also the appreciation of faint calcified vascular plaque suggesting the linear tubular density to be intra-arterial.
Case Discussion
This is an example of a fractured radial arterial line. The line was removed by the treating caregiver in the intensive care. The line fractured/fragmented on removal between the hub and cannula.
Complications of arterial lines include regional sepsis, pseudoaneurysm formation, ischaemic damage and arterial thrombosis 1. On rare occasions, the line may fracture/fragment and consequently, there is intra-arterial retention of the cannula tubing 1. This triggers surgical removal due to its potential long-term complications, as was the case here.
Ultrasound and X-rays can be utilised for localisation of retained intravascular lines/ foreign bodies. Endovascular retrieval and/ or surgical removal are the options for the removal of retained lines and foreign bodies.
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