Surgical retrieval of fragmented intravenous cannula tip from the cephalic vein

Rachel Dorairaj1, Shalini. S2, Vijayakumari. D3

1Nursing Supervisor, Kauvery Hospital, Electronic City Bengaluru

2Nursing Superintendent, Kauvery Hospital, Electronic City, Bengaluru

3Nursing Educator, Kauvery Hospital, Electronic City, Bengaluru

Introduction

Intravenous (IV) cannula are routine clinical devices, but fragmentation leading to vascular embolization is a recognized albeit rare complication, with an estimated prevalence of less than 1% for most peripheral IV complications. Intravenous catheter fragments lodged in the vascular system necessitate urgent retrieval due to the high risks of localized complications such as thrombosis and infection, and the critical danger of central migration, potentially leading to cardiac arrhythmia or pulmonary embolism. We report a case involving the successful surgical removal of a retained plastic cannula fragment from the left cephalic vein in a 20-year-old male. This case is clinically noteworthy as it demonstrates the rapid and effective management of a peripheral embolus using precise ultrasound-guided open surgical extraction under local anaesthesia, minimizing patient morbidity.

A 20-year-old male patient presented to the Emergency Room on 3 December 2025, with a history of a retained foreign body within the left arm. The patient was participating in a medical trial for a pharmaceutical company, during which an IV cannula had been placed in the left cephalic vein. The patient reported that the cannula broke, and the plastic tip became lodged inside the vein when he accidentally stood up.

On arrival, the patient was hemodynamically stable. Vital signs recorded a Heart Rate (HR) of 87/min, Oxygen Saturation (SpO2) 98.1%, Respiratory Rate (RR) 20/min, and Blood Pressure (BP) 134/97 mmHg. The patient reported a pain score of 3/10. He reported no known comorbidities or allergies. Local examination of the left arm revealed swelling over the site, and the patient was able to palpate the location of the retained tip. There were no immediate signs of distal compromise or severe infection (erythema or increased warmth) reported upon initial assessment.

The provisional diagnosis was an accidental cannula plastic tip stuck inside the vein. The patient was admitted to the ward under the care of the CTVS team for surgical management.

Investigations

Laboratory investigations were done immediately after admission on 3 December 2025.

Haematology (Complete Blood Count): Haemoglobin (Hb) was 13.9 g/dL, Total WBC Count was 7060 Cells/cumm, and Platelet Count was 245 x10^3/µL. Mean Corpuscular Haemoglobin Concentration (MCHC) was slightly elevated at 35.1 g/dl (Reference Interval: 31.5–34.5 g/dl).

Clinical Chemistry (RFT/LFT): Fasting Blood Sugar was 100 mg/dL. Renal function was stable (Serum Creatinine 0.7 mg/dL, Urea 13 mg/dL). Chloride was slightly elevated at 108 mmol/L (Reference Interval: 98–107 mmol/L). Aspartate Aminotransferase (AST) was 17 U/L and Alanine Aminotransferase (ALT) was 73 U/L.

Serology: Pre-operative screening confirmed non-reactive status for HIV 1 & 2 (Fourth Generation) and Anti HCV, and Hepatitis B Surface Antigen (HBsAg) was Negative.

Radiology: An urgent Upper Limb (UL) Doppler Ultrasound was requested to localize the retained foreign body and assess vascular integrity. Although a separate formal Doppler report is not available in the documentation, operative notes confirm that the migration and location of the IV cannula tip were verified using ultrasound guidance.

X-ray

Pre-operative Nursing Care

  • Verified and documented patient consent for the surgical procedure.
  • Confirmed allergy status as “Not Known”.
  • Ensured patient remained NPO (Nil Per Oral) prior to surgery.
  • Continuous monitoring of vital signs.
  • Administered pre-operative intravenous medications: PAN 40mg, EMESET 4mg, and AUGMENTIN 1.2gm.
  • Maintained intravenous fluid regimen: DNS/RL @ 100ml/hr.
  • Performed baseline neurovascular assessment of the left upper limb.
  • Provided psychological support and anxiety management to the patient, recognizing the stressful nature of the accident and admission within the context of a clinical trial.
  • Prepared the operative site and informed the surgical team (SOS).

Surgical Management / Procedure

The surgical management, described as the removal of the IV cannula, was performed on 3 December 2025.

  • Primary Surgeon: Madhusudan.
  • Anaesthesia: Local Anaesthesia (LA) with slight sedation.
  • Surgery Start Time: 11:15 AM.
  • Surgery End Time: 11:30 AM.

Under aseptic precautions, a skin incision was made over the presumed site. Utilizing ultrasound (USG) guidance, the cephalic vein was identified, and the migration of the IV cannula tip was confirmed. The vein was exposed, and a venotomy (incision into the vein) was performed. The cannula fragment was successfully removed. No intraoperative complications were documented. Post-removal confirmation was achieved via USG to reconfirm the absence of residual fragments. The venotomy and wound were closed.

Post-operative Course

In the immediate post-operative period (4 December 2025), the patient remained hemodynamically stable. Vital signs were stable, with a BP of 130/80 mmHg and SpO2 of 96%. Mild pallor was noted (+), interpreted as transient or mild reduction in baseline skin colour, but the patient’s overall condition and vital signs remained satisfactory. Clinical assessment confirmed a palpable radial pulse (90/min) and intact sensation (+).

The patient was maintained NPO for four hours post-surgery, followed by a progression to oral liquids and then a solid diet. Post-operative medications were instituted for prophylaxis and symptom control.

Post-operative Nursing Care

  • Transition from NPO status to oral diet after four hours.
  • Continuous monitoring of vital signs and neurological status.
  • Regular assessment of the wound dressing.
  • Maintaining limb elevation of the affected upper limb.
  • Frequent neurovascular checks (NV checks) of the left arm to assess for compromise, including:
    • Colour and Warmth
    • Capillary refill
    • Distal pulse (Radial pulse documented as present)
    • Sensation
  • Pain assessment using the pain score (P.S.) was conducted regularly.
  • Administration of prescribed post-operative medications: Tab CEFTUM 500mg (1-0-1) for 5 days, Tab 650mg (1-1-1) for 5 days, Tab CHYMORAL FORTE (1-0-1) for 5 days, and Tab PAN 40mg (1-0-0) for 7 days.
  • Patient education was provided on signs of infection and the importance of avoiding strain or excessive movement on the surgical limb to protect the repair site.

Outcome & Follow-Up

The retrieval procedure was completed successfully, resulting in the removal of the foreign body from the left cephalic vein. The patient remained stable throughout the post-operative course. The wound was managed with standard wound dressing. The plan was for observation and potential discharge following stabilization.

Discussion

Catheter embolization, as documented here, is a known mechanical complication of IV access, necessitating urgent intervention due to the associated morbidity and mortality. The location of this foreign body in the peripheral venous system (cephalic vein) conferred an immediate advantage over central migration, as retrieval was feasible via a minimally invasive open surgical approach under local anaesthesia. Catheter fragments pose a long-term risk of thrombosis, septicaemia, and further central embolization. Had the fragment migrated centrally, approaches such as percutaneous endovascular retrieval (using snares or baskets) would have been the primary choice; however, given the precise peripheral localization, open surgical management allowed for direct visualization and definitive removal in a swift, 15-minute procedure.

The immediate localization using clinical findings and subsequent confirmation via Upper Limb Doppler Ultrasound was critical. Utilizing USG guidance intraoperatively further enhanced the precision of the venotomy and confirmed the successful removal of the fragment, minimizing trauma to the vascular structures. The use of Local Anaesthesia with mild sedation was advantageous, promoting rapid recovery compared to general anaesthesia.

Conclusion

Surgical retrieval of a fragmented intravenous cannula tip from the left cephalic vein was successfully executed in a 20-year-old male. The swift diagnosis and focused open surgical approach, facilitated by real-time ultrasound guidance, ensured a favourable outcome with minimal recovery time. This case reinforces the vital role of bedside ultrasound in the emergency localization of retained foreign bodies. Furthermore, protocols for IV insertion and maintenance, particularly in high-volume settings like clinical trials, must be continuously reinforced to mitigate the risk of accidental device fragmentation.

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