Catheter

Fragmentation
Risk prevention by avoiding
reinsertion of IV catheters
Catheter Fragmentation Causes and Risks
IV catheter placement – a daily challenge When does it happen?

Risks of Reinsertion

Reinsertion can be considered as main cause of catheter fragmentation, resulting in catheter migration and in worst case embolism.

Attempt of reinserting the needle after unsuccessful or partial advancement of

Reinsertion the catheter increases risk of shearing off catheter tip.

Catheter Fragmentation Catheter Migration Catheter Embolism

Catheter fragments can migrate

Catheter fragmentation can occur
through veins and lodge in the vena Catheter embolism is caused by
due to reinsertion or accidental
cava, right atrium, right ventricle, or migrating catheter fragments in
cutting of the catheter sheath with
in the main pulmonary artery or one the circulatory system.
a scissor or scalpel.
of its branches.6
Cut catheter tip

Peripheral IV catheters are a crucial element of today’s infu- Such a loss or displacement of foreign material, such as
Example case
sion therapy and regular tool in clinical practice. Even though ruptured or sheared-off catheters, within the cardiovascular
Lee et al.3 published a case report of
a routine process, not every cannulation is successful on its system is not an uncommon event.
a patient with a sheared catheter
first attempt and may lead to catheter reinsertion. A study
fragment in the wrist after an arterial
has shown that reinsertion happens in up to 5 % of cathe- Shearing of catheter sheath by reinsertion of the steel needle
cannulation attempt.
terizations, resulting in a 23-fold risk of cannulation failure.1 due to unsuccessful cannulation is only rarely documented in
the medical scientific literature.4 However, the impact of un-
The first cannulation attempt was
Any attempt to reinsert the metal needle after advancement derreporting may be estimated to be high as it is known to be
not successful and instead of remov-
of the catheter carries the risk of catheter shearing due to the for needlestick injuries.5
ing the cannula and discarding the
sharp cutting edge of the needle bevel.2,3,4
catheter completely, the needle was
placed back into the catheter and
re-advanced. When removing the
catheter abruptly, only 1.8 cm of the
Reinsertion happens in up to

4.5 %
catheter was attached to the hub
while 1.2 cm were missing.

Investigations (ultrasound, x-ray,

CT-scan) revealed the 1.2 cm frag-
ment within the subcutaneous tissue
adjacent to radial arterial. Surgical
of catheterizations.1 removal was done successfully.

Microscopic view of sheared-off catheter tip (examplary)

Consequences Preventive Strategies
Impact of catheter embolism on patient health Strategies to help avoid catheter fragmentation

Catheter emboli are a significant risk to patient well-being. The extraction of embolized fragments is not always possi-
With a 49 % complication rate for indwelling catheter emboli, ble. Depending on the symptoms and surgical risks, smaller Do not reinsert the needle into the catheter after failed first attempt 3
the consensus is that these foreign bodies should be peripheral and often encapsulated foreign bodies may be
removed.2,3 left in situ – although control examinations must then be Avoid advancing both catheter and needle with needle already partially
performed. However, not removing the fragments can result withdrawn4
Before removal of the catheter emboli, in mortality.6
it has to be detected. To distinguish the
Once needle is partly removed from catheter withdraw needle completely
catheter sheath from the surrounding Apart from the risk for the patient, additional cost through Use of IV catheters with passive safety mechanism may help to prevent
tissue, X-ray, CT scan or ultrasound can additional examination (e.g. X-ray, CT, ultrasound) and
reinsertion of the needle into the catheter
be used.2,6 The radiopaque stripes in the percutaneous or surgical removal must be encountered.
catheter help to identify the catheter Follow instructions for use of IV catheter products
fragment through X-ray.7
Ensure correct position of the patient according to the procedure
The majority of catheter fragments are removed by percuta-
Avoid abrupt removement
neous extraction. However, if the emboli are in the heart or
central vasculature and percutaneous extraction fails, then Removed catheters should be checked for possible damages6
surgical removal (thoracotomy) is necessary.6
Ensure awareness and trained nursing staff on potential risk 8

Ways of catheter fragment removal 6

2.3 % Embolized fragments removed surgically via thoracotomy

4.2 % Fragments retained in the vascular bed

93.5 % Fragments removed percutaneously

Conclusion
Catheter reinsertion increases the risk of catheter shearing, resulting into catheter fragmentation, migration and subsequent catheter
embolism. This can lead to additional risks not only for the patient's health but als may require additional medical intervention (and
cost) to remove the catheter fragment.
B. Braun Safety IV Catheters
Passive safety mechanism to help avoid reinsertion Product Overview

The B. Braun Safety IV Catheters have a passive safety mechanism that is automatically activated once the needle is withdrawn Introcan Safety® 3 – Closed IV Catheter
out of the catheter hub, making reinsertion of the needle not possible.
„ Multi-access blood control septum
„ Passive safety shield
Step 1 Step 2 Step 3 „ Stabilization platform
„ Portfolio: G14-G24 / 19-50mm length
„ Available in PUR

Introcan Safety® – Safety IV Catheter

„ Passive safety shield

„ With/ without small wings
„ Portfolio: G14-G24 / 14-64mm length
„ Available in PUR & FEP

Introcan Safety® Deep Access – Safety IV Catheter for deep vein access
Passive Safety Shield „ Passive safety shield
is a passive, fully automatic protection of the needle tip „ Without smalll wings
It deploys automatically and requires no user activation
„ Longer indwell times 11
„ Portfolio: G18-G22 / 64mm length, G24 / 32mm
Cannot be bypassed „ Available in PUR
Designed to eliminate needlestick injuries and related infections 9,10
Vasofix® Safety – Safety IV Catheter with injection port
Passive Safety is most effective at preventing needlestick injuries 9,10
P assive Safety is proven to be better than a semi-automatic ‘push-button’ „ Injection port
safety shield or manually sliding shield10 „ Passive safety shield
„ Fixation wings
„ Portfolio: G14-G24 / 19-50mm
„ Available in PUR & FEP
References

1. Mörgeli R, Schmidt K, Neumann T. et al. A comparison of 7. Kim I-S, Shin H-K, Kim D-Y. Iatrogenic catheter sheath shearing
first-attempt cannulation success of peripheral venous catheter during radial artery cannulation. Korean J Anesthesiol. 2013
systems with and without wings and injection ports in surgical Dec; 65(6 Suppl):S12-13
patients—a randomized trial. BMC Anesthesiol.2002; 22(88):1-11. 8. Sotak M, Capek V, Tyll T. Where Did the Midline Catheter
2. Stertmann W.A., Rauber K, Kling D. Embolisation einer Venen- Disappear. Clin. Med. Insights. 2021;14:1-2.
verweilkanüle. Notfallmedizin. 1989; 15(7): 484-486. 9. Tosini W. et al. Needlestick Injury Rates According to Different
3. Lee S-Y, Na H-S, Kim M-H, Kim C-S, Jeon Y-T, Hwang J-W, Do Types of Safety-Engineered Devices: Results of a French
S-H. A Sheared Catheter Fragment in the Wrist after Arterial Multicenter Study. Infection Control & Hospital Epidemiology.
Cannulation Attempt. Korean J Crit Care Med. 2010 Jun;25 April 2010; 31(4):402-407.
(2):118-121. 10. Sossai D. et al. Efficacy of safety catheter devices in the
4. Glassberg E, Lending G, Abbou B, Lipsky A. M. Something’s prevention of occupational needlestick injuries: applied
Missing: Peripheral Intravenous Catheter Fracture. JABFM; research in the Liguria Region (Italy). J Prev Med Hyg.
Nov-Dec 2013, 26 (6):805-806. 2016; 57:110-E114.
5. Osborne S. Perceptions that influence occupational exposure 11. Bahl A, Hang B, Brackney A, Joseph S, Karabon P, Mohammad
reporting. AORN J. Aug 2003;78(2):262-272. A, Nnanabu I, Shotkin P. Standard long IV catheters versus
6. Surov A, Wienke A, Carter JM, Stoevesandt D, Behrmann C, extended dwell catheters: A randomized comparison of ultra‑
Spielmann RP, Werdan K, Buerke M. Intravascular embolization sound-guided catheter survival.The American journal of
of venous catheter – causes, clinical signs, and management: emergency medicine. 2019; 37(4): 715-721.
a systematic review. JPEN J Parent Enteral Nutr. 2009
Nov-Dec; 33(6):677-85

B. Braun Melsungen AG | Hospital Care | 34209 Melsungen | Germany

Tel. +49 5661 71-0 | www.bbraun.com

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Date of last revision: 03.2023