Implanted central venous catheters (infuse port catheters) are widely used in pediatric patients with malignancy or chronic diseases with long-term venous access needs. Indications for port-a-catheter removal include treatment completion, documented line sepsis, catheter fracture, blockage, or thrombosis. Port catheter removal is usually a simple procedure; however, retrieval of stuck, usually long-standing catheters, can be challenging [1,2,3], and the incidence of a stuck catheter has been reported with wide variation. The incidence range reported is 0.3 to 2.2% in various studies [4, 5]. Nonetheless, we believe that there is a lack of reporting, and data are scarce in general regarding this common procedure.

The pathogenesis behind the “stuck” catheter is related to forming a peri-catheter sleeve of fibrin sheath. Experimental studies on postmortem animals performed during the 14 days after catheter insertion confirmed the presence of foci of local intimal injury, endothelial denudation, and adherent thrombi [6, 7]. Several reports claim that long duration of use (> 20 months) and hematological disorders are the main predisposing factors associated with the difficult removal of the port-a-catheters [1, 4, 8]. In hematological patients, there was no clear pathogenesis for stuck catheters found in the literature to explain such predisposition. Catheters in these children are kept for a long time with multiple insertions because of the need for prolonged treatment such as chemotherapy. Also, catheter damage, fibrosis, and adhesion have been reported when the catheter is compressed between the clavicle and first rib and chronic friction (the pinch-off syndrome) [9].

Removal of a stuck catheter can be difficult, and forceful pulling of a stuck catheter alone without any safer technique of removal can lead to catheter breakage with consequent retention or migration of the broken fragment; even more, a catastrophic event may occur secondary to bleeding and rupture of the vessel wall [5, 10]. Some have reported that medium-term follow-up for children with retained catheter fragments has been unremarkable; however, those children are at risk of thrombosis, infectious complications, myocardial perforation, endocarditis, arrhythmias, and catheter migration to pulmonary vasculature with a potential risk of pulmonary embolism [1, 4, 8, 11].

Different techniques for dealing with stuck catheters have been described. Endoluminal balloon dilatation, the Hong technique, is the most used [12]. Huang et al. reported their experience with one patient utilizing a guide wire to separate the catheter from the vessel wall, recognized as a “push-in” force technique [13]. A migrated catheter can be retrieved by interventional radiology using an EN Snare device [3, 14]. The retained fragment is occasionally left in place or anchored to surrounding tissues to decrease migration risk [1, 15]. Migrated fragments may require a more invasive approach, including open sternotomy with pulmonary arteriotomy [16]. This study aims to describe our experience utilizing a relatively feasible and simple alternative technique for removing stuck port-a-catheters and reviewing the factors associated with such intraoperative difficulties.