PMC5350341_01
Wire fragment extending out of skin. During removal, the central stimulating wire and coil structure were noted to be fractured. Yellow arrows: wire fragment.
CRIA2017-7196340.001.jpg
PMC5350341_01_CRIA2017-7196340.001.jpg
fig1
The surgeon was able to remove the entire polyurethane catheter body without difficulty, but during removal, the central stimulating wire and coil structure were noted to be fractured, with approximately 3 cm remaining above the skin level (Figure 1).
Infraclavicular neurovascular sonoanatomy with arm position adducted. The ultrasound image represents a transverse view with the top of the image displaying the ultrasound probe position. Arrows: needle shaft, A = axillary artery.
CRIA2017-7196340.002.jpg
PMC5350341_01_CRIA2017-7196340.002.jpg
fig2
Since the arm was unable to be abducted, the infraclavicular neurovascular sonoanatomy was more challenging to interpret, as it appeared different than when the catheter was inserted (Figure 2).
Removal of the fractured peripheral nerve catheter fragment. Traction was applied to the fragment while observing real-time removal with ultrasonography. Yellow arrows: wire fragment.
CRIA2017-7196340.003.jpg
PMC5350341_01_CRIA2017-7196340.003.jpg
fig3
A clamp was attached to the wire fragment and gentle traction was applied while observing the wire under real-time ultrasonography (Figure 3).
The stimulating wire and coil fragment following removal.
CRIA2017-7196340.004.jpg
PMC5350341_01_CRIA2017-7196340.004.jpg
fig4
The wire was successfully removed with the tip intact (Figure 4).
Follow-up ultrasound evaluation of the infraclavicular brachial plexus region with arm abducted and externally rotated. The ultrasound image represents a transverse view with the top of the image displaying the ultrasound probe position. A = axillary artery, LC = lateral cord, MC = medial cord, and PC = posterior cord.
CRIA2017-7196340.005.jpg
PMC5350341_01_CRIA2017-7196340.005.jpg
fig5
During this follow-up visit, an ultrasound evaluation (GE Healthcare, Logiq  P6, 11L probe, Chicago, IL, USA) revealed normal infraclavicular brachial plexus anatomy when the patients arm was abducted and externally rotated (Figure 5).