A broken catheter - Nightmare in cathlab

This is a case of how a broken diagnostic catheter inside the axillary artery was removed. New innovative ideas helped to achieve this.

1. BROKEN CATHETER A nightmare DR. ANSHU KUMAR JHA, DM RESIDENT, MKCG MEDICAL COLLEGE AND HOSPITAL, BERHAMPUR, ODISHA

2. CASE HISTORY 72 yrs old, male patient, hypertensive since 20 years presented with sudden onset shortness of breath and sweating 3 days ago at a PHC. He was a non-diabetic, chronic smoker No family history or any such episodes in the past Following initial treatment on the line of ACS he was referred to us for further management BP - 150/100 mmHg, PR - 98/min, JVP - normal, CVS - normal S 1 S 2 , no added sounds, RS - NVBS

3. ECG - Pathological q wave with T wave inversion in II, III, aVF and V 3 -V 6 Hb - 12 gm% Creatinine - 1.0 mg% Platelet - 2.06 lakhs/mm 3 ECHO - LCX territory hypo-kinetic, RCA territory akinetic with Ef - 37%. No MR Treatment - - Aspirin, Atorvastatin, Clopidogrel - Enoxaparin - Metoprolol and ramipril

4. CORONARY ANGIOGRAPHY Right radial approach taken Tiger catheter 6F (3cm) used After inserting the radial sheath the guide catheter was advanced over the guide wire When the catheter reached near the subclavian artery resistance was felt for the guide wire to pass Even after 2-3 attempts we were not able to cross the wire So, we pulled back the guide catheter and took out the guide wire to inject the dye and try to locate the obstruction Before injecting when we did fluoroscopy the “ TIP WAS BROKEN ” and moving to and fro in the axillary artery

5. We tried to pass a guide wire via the broken segment but we were unsuccessful

6. After this we prepared our own snare - 1. 1 st guidewire put into the catheter 2. 2 nd guidewire was put through the catheter and balloon passed over it 3. Now the free end of the 1 st guidewire (near the tip of catheter) was folded and put back into the catheter and the balloon inflated to press that segment of wire against the wall of the catheter. 4. The other free end of 1 st guidewire which was lying out of radial sheath could be used to manipulate the diameter of the loop Next we put this assembled snare into the radial sheath and tried to hook the broken tip

7. TAKE HOME MESSAGE Mishaps are not uncommon in cath lab Innovative ideas and tactful handling of the situation can avoid referral of the patient Always check the bends of the catheter before using it Avoid reuse of hardware