# Intravascular Rewarming in Major Burns: A Rare but Serious Catheter-Related Complication

## TL;DR

This paper reports a rare complication during the removal of an intravascular warming catheter in a burn patient, highlighting the importance of managing such devices carefully.

## Contribution

The paper presents the first documented case of catheter entrapment and balloon detachment during intravascular rewarming in a burn patient.

## Key findings

- An intravascular warming catheter was successfully used to treat hypothermia in a severely burned patient.
- Catheter removal was complicated by balloon detachment, requiring multidisciplinary intervention for safe removal.
- Venous stenting was used to secure the detached balloon fragment and prevent further complications.

## Abstract

Introduction: Patients with major burn injuries are highly susceptible to hypothermia due to extensive skin loss, aggressive fluid resuscitation, repeated surgical procedures, and exposure during wound care. Hypothermia is associated with coagulation disorders, increased blood loss, impaired immune response, prolonged hospitalization, and increased mortality. When conventional warming strategies fail, intravascular temperature management systems may be employed, although they carry risks inherent to central venous catheters. Case Report: We report the case of a 26-year-old male with 66% total body surface area flame burns and inhalational injury, admitted to the Burns Intensive Care Unit with persistent hypothermia despite standard warming measures. An intravascular temperature management catheter was inserted via the femoral vein and successfully restored normothermia. Due to clinical instability, the catheter remained in situ beyond the recommended duration. During attempted catheter removal, significant resistance was encountered, raising concern for mechanical malfunction. Imaging confirmed catheter entrapment without fracture. Multidisciplinary management involving vascular surgery and interventional radiology enabled successful removal using endovascular snare techniques. A detached balloon fragment was identified and secured with venous stenting. Conclusions: This report describes the first documented case of complicated removal of an intravascular warming catheter due to balloon detachment in burn patients. Physicians using these devices should be aware of this possible complication and be prepared for its management.