Fluoroscopy-guided guidewire-assisted technique for difficult removal of a peripherally inserted central venous catheter (PICC) in children: a report of three cases and literature review.

Background: In general, it is relatively easy to remove peripherally inserted central venous catheter (PICC) by gentle traction without any complications. However, the removal of PICC can be challenging occasionally. If the standard interventions fail to remove the catheter, there are no clear recommendations about what to do. We presented three cases to explore fluoroscopy-guided guidewire-assisted technique for removal of the firmly adherent PICC.

Case description: Three cases of difficult PICC removal were all children with acute lymphoblastic leukemia (ALL). All cases were male, range 3-6 years, mean 5.00±1.73 years, catheter indwelling time 289-433 days, mean 367.33±72.83 days. All three cases underwent PICC intubation via the basilic vein approach and all catheters were 3.0 French (Fr), silicone, single-lumen PICCs (Bard Access Systems, Inc., Salt Lake City, UT, USA). Removal of the PICC at the end of the treatment course was difficult. The pullback of the catheter went smoothly for the first few centimeters, but then resistance was encountered. The catheter did not move backward at that point, although we applied strong continuous traction. Several noninvasive approaches to remove the catheter (e.g., repositioning of the extremity, application of hot compress, and vascular massage) were all with no success. Eventually, the firmly adherent PICC was removed using fluoroscopy-guided guidewire-assisted technique in hybrid operating room safely and successfully.

Conclusions: Difficult PICC removal can result after prolonged dwell times. When conventional noninvasive interventions are unsuccessful, fluoroscopy-guided guidewire-assisted technique is a safe and effective method for the removal of adherent PICC.