Advertisement

Fracture of an Intravenous Cannula in the Hand: A Case Report

Published:December 31, 2022DOI:https://doi.org/10.1016/j.jen.2022.11.012

      Abstract

      Background

      Intravenous cannula insertion is important, given that it is the most common invasive procedure in the emergency department for blood sampling, fluid resuscitation, and intravenous drug administration. Complications of intravenous catheterization include pain, phlebitis, extravasation, inflammation, and embolization. Fracture of an intravenous cannula is rare, but delayed removal may result in secondary damage, such as vasculitis or embolization, with critical consequences. Here, we report a case of intravenous cannula fracture that occurred in our emergency department.

      Case Presentation

      A 63-year-old woman with a history of left ovarian cancer visited our emergency department owing to poor oral intake and general weakness. Intravenous catheterization using an 18 gauge cannula was attempted for intravenous fluid administration by a skilled operator, but it failed owing to collapsed veins and poor skin condition. After several attempts, a vein in the patient’s hand was ruptured, and the patient complained of severe pain. The cannula was removed, but one-third of the cannula tip could not be seen. X-ray imaging was performed to locate the fragment of the cannula, and venotomy was performed for removal of the foreign body in the emergency department.

      Conclusion

      Emergency physicians and nurses should be vigilant about potential risk factors that can cause fracture of an intravenous cannula, and after the fracture is discovered, rapid removal of the cannula tip should be performed in the emergency department.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Marsh N.
        • Webster J.
        • Ullman A.J.
        • et al.
        Peripheral intravenous catheter non-infectious complications in adults: a systematic review and meta-analysis.
        J Adv Nurs. 2020; 76: 3346-3362https://doi.org/10.1111/jan.14565
        • Abolfotouh M.A.
        • Salam M.
        • Bani-Mustafa A.
        • White D.
        • Balkhy H.H.
        Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications.
        Ther Clin Risk Manag. 2014; 10: 993-1001https://doi.org/10.2147/TCRM.S74685
        • Singh S.
        • Prakash J.
        • Shukla V.
        • Singh L.K.
        Intravenous catheter associated complications.
        J Assoc Physicians India. 2010; 58: 194-196
        • Kagel E.M.
        • Rayan G.M.
        Intravenous catheter complications in the hand and forearm.
        J Trauma. 2004; 56: 123-127https://doi.org/10.1097/01.TA.0000058126.72962.74
        • Richardson J.D.
        • Grover F.L.
        • Trinkle J.K.
        Intravenous catheter emboli: experience with twenty cases and collective review.
        Am J Surg. 1974; 128: 722-727https://doi.org/10.1016/0002-9610(74)90057-9
        • Bakhshi G.D.
        • Parikh A.K.
        • Rahul K.
        • Bagul A.G.
        • Gangawane S.D.
        Broken intravenous angiocath–a case series.
        J Med Sci Clin Res. 2019; 7: 11-14https://doi.org/10.18535/jmscr/v7i6.03
        • Singh A.
        • Kaur A.
        • Singh M.
        • Kaur S.
        CT guided removal of iatrogenic foreign body: a broken intravenous cannula.
        J Clin Diagn Res. 2015; 9: PD28-PD29https://doi.org/10.7860/JCDR/2015/14344.6549
        • Lee S.Y.
        • Na H.S.
        • Kim M.H.
        • et al.
        A sheared catheter fragment in the wrist after arterial cannulation attempt: a case report.
        Korean J Crit Care Med. 2010; 25: 118-121https://doi.org/10.4266/kjccm.2010.25.2.118
        • Turner D.D.
        • Sommers S.C.
        Accidental passage of a polyethylene catheter from cubital vein to right atrium: report of a fatal case.
        N Engl J Med. 1954; 251: 744-745https://doi.org/10.1056/NEJM195410282511806
        • Arun O.
        • Oc B.
        • Gunduz E.
        • Oc M.
        • Duman A.
        Fracture of an intravenous cannula in the vein due to reinsertion of the guide needle: a case report.
        J Cardiovasc Surg. 2014; 2: 28-29https://doi.org/10.5455/jcvs.2014224
        • Khoo P.J.
        • Tay K.L.
        • Jamaluddin A.A.
        • Gunasaker D.
        Self-inflicted and iatrogenic peripheral intravenous cannula fracture: a case report.
        Ann Med Surg (Lond). 2018; 33: 44-46https://doi.org/10.1016/j.amsu.2018.08.004
        • Gschwind C.R.
        The intravenous foreign body: a report of 2 cases.
        J Hand Surg Am. 2002; 27: 350-354https://doi.org/10.1053/jhsu.2002.31148
        • Tanabe H.
        • Takahashi T.
        • Murayama R.
        • et al.
        Using ultrasonography for vessel diameter assessment to prevent infiltration.
        J Infus Nurs. 2016; 39: 105-111https://doi.org/10.1097/nan.0000000000000159

      Biography

      Seungho Woo is a Resident, Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea. ORCID identifier: https://orcid.org/0000-0002-6611-7717.

      Biography

      Sangun Nah is a Clinical Professor, Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea. ORCID identifier: https://orcid.org/0000-0003-2667-2211.

      Biography

      Giwoon Kim is an Associate Professor, Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea. ORCID identifier: https://orcid.org/0000-0003-2720-7442.

      Biography

      Sangsoo Han is an Assistant Professor, Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea. ORCID identifier: https://orcid.org/0000-0002-9709-3332.