Infected Retained Catheter-Related Sheath, an Underrecognized Complication of Central Venous Catheter Insertion: A Case Report

Patient: Female, 45-year-old Final Diagnosis: Infected retained catheter-related sheath Symptoms: Fever • Nausea • Vomiting Medication: — Clinical Procedure: Mechanical thrombectomy • transesophageal echocardiogram Specialty: Cardiology • Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: Central venous catheters are indicated for a variety of conditions, including hemodynamic monitoring, hemodialysis, and long-term antibiotic and chemotherapy delivery. Several million are placed each year. Development of a fibrin sheath around the catheter is a common occurrence, with a reported incidence of 42–100% within 7 days of catheter placement. It is uncommon for these sheaths to be left in the patient upon removal of the catheter and even far more uncommon for these retained sheaths to lead to complications. CASE REPORT: We present the case of a 45-year-old woman with a previous history of superior mesenteric artery syndrome and chronic protein calorie malnutrition on total parenteral nutrition through a long-term indwelling central venous catheter. She presented with concerns of persistent bacteremia despite outpatient intravenous antibiotic therapy, requiring removal of her central venous catheter. A transesophageal echocardiogram was performed to rule out infective endocarditis. Findings showed a highly mobile mass extending from the superior vena cava into the right atrium, most consistent with a retained catheter-related sheath. Due to concern for this being a nidus of her persistent bacteremia, she underwent mechanical thrombectomy, with excellent results and subsequent clearing of her bacteremia. CONCLUSIONS: Placement of central venous catheters is becoming a commonplace occurrence, with millions placed each year. Retained catheter-related sleeves are a potential complication, with further research needed to help determine the clinical significance and best treatment approach.