Peripheral IV cannulation is a common procedure. Approximately 60% of all patients treated by a healthcare system will have an IV cannula inserted for varying purposes,. Intra venous access required for sampling of blood as well as administration of fluids, medications, nutrition and blood products It can be associated with complications such as infiltration to nearby nerves, tendons and blood vessels, thrombophlebitis, venous spasm, hematoma, air embolism and cannula associated blood stream infections. Among the complications of peripheral venous cannulation, intravascular fracture of the cannula stem is an uncommon complication. Its exact incidence is unknown and not much literature is available.
Peripheral venous canula has several components. Out of the parts of a cannula, catheter part is the intravenous part and liable for damage or fracture. The broken off piece of a cannula within a vein will act as an intravascular foreign body which can embolize. Embolism of broken cannula segments may result in sepsis, endocarditis, cardiac perforations and arrhythmias,.
Intravenous cannula can fracture due to various reasons. Repeated attempts at insertion, repeated insertion of the introducer needle, poor quality cannulas and keeping the cannula in situ for prolonged periods have been cited as reasons for breakage of these devices,. Reinsertion of the introducer needle into the cannula during repeated attempts at cannulation can damage the catheter part of the device. This can lead to complete fracture or partial damage to the tip. A partially damaged cannula can completely transect at the time of its removal,.
In majority of orthopedic patients uses assistive walking devices ( walking frame, crutches)to walk. Most of these patients , peripheral intravenous canula lines are placed at the dorsum of the hand or wrist, either in the cephalic vein or basilic vein.
Even though the outer part of the canula placed distal to the wrist, the catheter part stay intravenous across the wrist. When the patient mobilizes with a walking aid, patient’s wrist get bended to hold the walking aid. When the wrist bend , the catheter portion of the IV cannula also get bended(Fig1 ). Due to the inherent nature of the flexibility of catheter part, canula get bended at the neck of the canula. Repeated bending of plastic catheter can result in failure of it integrity and facture of the catheter part of the canula. (Fig 2) In our patient obviously the canula was placed at the cephalic vein near the wrist. When the patient holding the walking frame, wrist is getting bended and body weight loads at wrist. It is very obvious , catheter of the canula is bended at the neck of the cannula. The frequent bending with loaded weight might have resulted in a fatigue fracture of the canula.
Most of the time intravenous fracture of a cannula can be detected at the time of the removal of it. Otherwise nonfunctioning canula, local swelling and pain at the place of a canula or symptoms attributable to distal embolization,may suspect for it. Or it may be totally asymptomatic and will get noted at the time of the removal, . Distal symptoms caused by catheter embolization included cardiac palpitations , dyspnea, cough, or chest pain,. Sometimes it might give rise to distal septic complications.
When a cannula fracture is diagnosed the major issue is to trace the broken part. Attempt on tracing along the vein by palpation may dislodge the broken part and facilitate the embolization. Applying a tourniquet band proximal to the site can reduce the risk of embolization. But application of tourniquet should be for a shorter period to prevent tourniquet complications.
Since these devices are made out of plastic material they are radiolucent in plain Xray imaging. Ultrasound scan of the location will help to localize it. Deep seated places like chest wall and neck CT scan will help to localize it,.
Proper training and technique can prevent potential complications associated with peripheral cannulation. Reintroduction of the needle into a partially inserted cannula should be avoided. Once inserted, the cannula insertion site should be regularly monitored. At removal the cannula should be checked for its completeness. If a piece of the cannula is missing some recommend an immediate proximal tourniquet to prevent migration of the missing segment until it is localized and removed,[5,6]. Tourniquet application should be handle with caution to prevent complications.