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Case 111: Chemotherapy infusion device

You are asked to remove an infusa-port from a 42 year old woman who has completed her chemotherapy for breast cancer. The device has been there for over 2 years. The procedure is simple however you arrange a chest xray in the recovery room and it reveals a complication.

1. What has occurred?

the catheter has fractured and a 7 cm remnant has passed through the right atrium into a branch of the left pulmonary artery.

2. How would you manage this problem?

The patient needs to informed of the complication. A CTPA can then be used to determine the exact location of the catheter and plan retrieval. If the fracture occurredd some time ago there is a risk that it may have eroded through the wall of the artery or be surrounded in organised thrombus.

Interventional radiology techniques can then be used to snare and retrieve the catheter via a femoral vein puncture.