Seek and You Shall Find—Retrieval of a Retained Fractured Intravenous Cannula by Z-Plasty Incision: A Case Report 

Ikechukwu Ezeah1  , Michael Chukwugoziem Nweke2  , Oluseyi Ademola Adejumo3  , Oladimeji Adedeji Junaid3  , Oluwole Olugbenga Ige1  

1Department of Surgery, University of Medical Sciences, Ondo State, Nigeria
2Department of Anatomic Pathology, University of Medical Sciences, Ondo State, Nigeria
3Department of Internal Medicine, University of Medical Sciences, Ondo State, Nigeria

Correspondences to: Ikechukwu Ezeah; email: iykeezeah1@gmail.com 
Received: 25 Oct 2021; Revised: 04 Jul 2022; Accepted: 02 Aug 2022; Available online: 29 Aug 2022

Abstract

Peripheral venous cannulation is a common invasive procedure. Fracture of an intravenous cannula is rare and an under-reported complication of peripheral venous cannulation. Embolization of the intravenous fragment into the central venous system is potentially fatal. Urgent surgical retrieval, which is performed through a transverse or longitudinal incision, is the treatment of choice. We herein present the use of Z-plasty incision for the retrieval of a retained fractured peripheral intravenous cannula in a 61-year-old Nigerian man on hemodialysis for chronic kidney disease. The major benefits of this innovation are facilitation of access for exploration and prevention of joint contracture.

Key words: Fractured intravenous cannula, Surgical retrieval, Z-plasty, Incision, Case report 

Ann Afr Surg. 2023; 20(1): **-**

DOIhttp://dx.doi.org/10.4314/aas.v20i1.12

Conflicts of Interest: None

Funding: None

© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction

Peripheral vein cannulation is a common invasive procedure performed for blood sampling, drug administration, parenteral fluid administration, and patient monitoring(1). However, it may be associated with complications such as extravascular infiltration, thrombophlebitis, bacteremia, septicemia, embolism, hematoma, and surrounding soft tissue damage, i.e., tendon, nerve, and muscle damage (2).
Fracture of a peripheral intravenous cannula is a rare and under-reported complication that is potentially serious(2). Its most feared sequelae include dysrhythmia and myocardial infarction, which occur secondary to proximal embolization of the retained fractured segment into the central venous system. Distal embolization has also been reported(3). Early diagnosis and detection of the retained fractured cannula fragment and its subsequent removal are important in preventing embolization and potential complications. Radiologic modalities for detection of the retained fractured fragment include plain x-rays(4), ultrasonography(2,5), computed tomography (CT) scan(6), and C-arm fluoroscopy(4), and these procedures are accompanied by surgical retrieval of the retained fractured cannula fragment.
In resource-poor settings, as may be seen in low- and medium-income countries (LMICs) with inadequate or inappropriate radiologic facilities aforementioned above, clinical presentation, physical examination, and reliance on a detailed knowledge of venous anatomy may be relied upon to surgically retrieve the retained fractured cannula fragment. The surgical techniques published in literature for retrieval of the retained fractured cannula segment include transverse (5–7) or longitudinal incisions(2,8). To our knowledge, there is no previous report of the use of a Z-plasty incision for this procedure.
This case report aimed to showcase the utility and application of a Z-plasty technique as a preferred option for surgical exploration and retrieval in an unlikely rare presentation of a retained fractured intravenous cannula.

Case presentation

A 61-year-old Nigerian man with poorly controlled hypertension complicated by chronic kidney disease with uremic gastritis presented at the emergency unit with complaints of generalized body weakness, history of repeated vomiting, and hiccups. Physical examination revealed a resting tachycardia of 112 bpm and an elevated blood pressure of 240/120 m