A Systematic Review of Intracardiac Embolization of Central Venous Catheter Fragment-Unraveling Pandora's Box.

In 30 seconds

This systematic review examined how the time from central venous catheter (CVC) implantation to identification of an intracardiac catheter fragment related to clinical presentation and management. Across 295 reported cases, 62.4% of embolizations were identified within the first year. CVC malfunction was associated with the shortest median duration to identification (37.5 weeks; IQR 13–53.2), and shorter duration predicted greater success with percutaneous retrieval (odds ratio 1.007, 95% CI 1.004–1.010; P < .0001). The authors suggest that earlier identification, particularly when a CVC malfunctions, may improve retrieval success.

Key findings

• Of 295 cases, 62.4% of catheter fragment embolizations were identified within the first year; 13% involved the pulmonary artery only.
• The malfunctioning-CVC group had the shortest median duration to identification: 37.5 weeks (IQR 13–53.2; P < 0.05 vs asymptomatic and symptomatic groups).
• Shorter duration predicted higher percutaneous retrieval success (odds ratio 1.007, 95% CI 1.004–1.010; P < .0001).
• Symptomatic presentation was associated with a higher probability of non-percutaneous retrieval (odds ratio 0.195, 95% CI 0.063–0.610; P = 0.0448).

Why it matters

Intracardiac CVC fragments can be managed percutaneously, surgically, or without retrieval, and this review links timing and presentation with the intervention used and retrieval success. The findings highlight catheter malfunction as a potential prompt to identify embolization and assess retrieval options, while the evidence remains based on reported cases rather than a comparative trial.

What to keep in mind

The review aggregates reported cases, so its findings are observational and may be affected by case selection and reporting; it does not establish that earlier identification causes greater retrieval success.