Chapter 32 ■ Central Venous Catheterization 211

b. In the event of catheter breakage, immediately grasp

and secure the extravascular portion of the broken

catheter to prevent migration.

c. If the catheter is not visible outside the baby, apply

pressure over the venous tract above the insertion

site to prevent the catheter from advancing.

Immobilize the infant, and obtain a radiograph

immediately to localize the catheter.

d. Surgical and/or cardiothoracic intervention may be

required if the catheter is not visible externally (27).

e. Damaged or broken catheters must be removed and

replaced. Repaired catheters and catheter replacement over a guidewire place the patient at risk for

infection or embolization. If no other options exist

owing to limited venous access, the catheter can

sometimes be repaired, utilizing meticulous aseptic

technique. Repaired PICCs should be considered

temporary, and a new catheter should be placed as

soon as possible. Some manufacturers offer repair

kits and instructions. A butterfly or blunt needle

may be used in an emergency (28) (Fig. 32.16).

9. Tethered catheter

a. Difficulty in removing catheter may be due to the

formation of a fibrin sheath or secondary to sepsis.

b. Management

(1) Place warm compresses on skin along the vein.

(2) Use gradual, gentle traction on the catheter.

(3) Thrombolytic therapy (29)

(4) Surgical removal through a peripheral incision

References

1. Ainsworth SB, Clerihew L, McGuire W. Percutaneous central

venous catheters versus peripheral cannulae for delivery of parenteral nutrition in newborns. Cochrane Database Syst Rev.

2007;CD004219.