Approach to Fragmented Central Venous Catheters

Abstract

Prolonged venous access devices are needed in cancer patients for central venous access. Catheter fragmentation leading to catheter malfunction represents a rare problem. Herein we present our experience in the management of fragmented catheters. Between 2001 and 2003, 183 catheters were placed via the subclavian vein, and five cases of fragmented catheters were observed. Fragments were removed by an Amplatz gooseneck snare (Microvena, St. Paul, MN) with angiographic intervention. The diagnosis of the breakage was made by chest radiography. The incidence of catheter breakage was 2.7%. All fragments were removed by the snare, without any complications. Catheter narrowing and breakage owing to its medial positioning in the subclavian vein were the main causes of catheter malfunction. In any case of catheter malfunction, radiologic evaluation of the catheter must be done to rule out its rupture. Removal of the fragments using the Amplatz snare is a safe and easily applied procedure.

Spontaneous fracture and migration of catheter of a totally implantable venous access port via internal jugular vein - a case report

“…A catheter fracture with subsequent migration is a rare complication after the TIVAP implantation [ 5 ]. But, rupture of the catheter is potentially severe complication [ 2 ].…”

Percutaneous Retrieval of an Embolized Central Venous Chemoport in a Patient With Colon Cancer

“…Catheter transection with subsequent embolization is a rare complication after the central venous device implantation 3)4). Particularly, it can happen when a central venous catheter is compressed vigorously and repeatedly between the clavicle and the first rib in the case of insertion with subclavian approach.…”

Transluminal Removal of a Fractured and Embolized Indwelling Central Venous Catheter in the Pulmonary Artery

“…Catheter fracture is a rare complication associated with these devices, with an estimated rate of 0.1~1%7, 13). Implantable central venous access devices placed via the subclavian vein may become obstructed by thrombosis, impingement against a vein wall, or a compression between the clavicle and first rib8).…”

“…In cases of catheter narrowing, patients should be followed carefully by chest radiography every four weeks, and the catheter should be removed within six months following insertion11). The presence of a fragmented central venous catheter should lead to immediate removal to prevent thromboembolic events13). With the goal of avoiding such fractures, insertion of the catheter lateral to the mid-clavicular line is recommended.…”