Catheter fracture: A rare complication of totally implantable subclavian venous access devices

Klotz, Hans; Schöpke, W; Kohler, A.; Paulweber, Bernhard; Largiadèr, F

doi:10.1002/(sici)1096-9098(199607)62:3<222::aid-jso14>3.0.co;2-8

Cited by 79 publications

(41 citation statements)

References 5 publications

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“…3). Although comparisons between patient groups are difficult, the 0.78 % incidence of catheter embolization seen in our study is consistent with the fracture and embolization rate of 0.1 to 2.1 % reported in other series [16,17]. Similar to patients described in other studies, our patient was asymptomatic after catheter fracture, and embolization.…”

Section: Discussionsupporting

confidence: 92%

Totally Implantable Venous Access Devices in Children Requiring Long-Term Chemotherapy: Analysis of Outcome in 122 Children from a Single Institution.

Shankar

Jadhav

Ravindra

et al. 2016

Indian J Surg Oncol

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Children with malignancy require venous access that is reliable, safe and compliant on a long-term basis. There is little data available on utilization of totally implantable venous access devices (TIVAD) for long term chemotherapy in children in an Indian setting [1]. We report our long-term follow-up results of utilization of totally implantable venous access devices for long-term chemotherapy in children. This was a retrospective analysis of 122 children requiring longterm chemotherapy done between January 2008 and December 2013. Data collected included primary disease process, type of port, site of insertion, intraoperative events, early and late postoperative complications, and issues with utilization, maintenance and removal. 127 ports were placed in 122 children. The follow up ranged from 16 to 50 months. Internal jugular vein was accessed in 96.8 % of cases (123/127). Majority of children (61 %) had hematological malignancy. Early complications occurred in 5 children. Late complications occurred in 18 children which included port pocket infection in 3, port site skin issues in 5, catheter related issues in 3, venous thrombosis in 2 and catheter related bacteremia in 5 children respectively. Only 10 children have been lost to follow-up either due to death or discontinuation of treatment and rest are on follow up. Totally implantable venous access devices usage is safe and reliable for access needs in children for longterm chemotherapy. Their low complication and low cost maintenance should increase their utilization in children requiring long-term chemotherapy. Chemoport placement in children with hematological malignancy can be carried out safely without much impact on complication rates. Though management and compliance of children with malignancy has improved; critical analysis and standardization of port system care through prospective trials are necessary to reduce the morbidity and for cost analysis in these children.

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Section: Discussionsupporting

confidence: 92%

Totally Implantable Venous Access Devices in Children Requiring Long-Term Chemotherapy: Analysis of Outcome in 122 Children from a Single Institution.

Shankar

Jadhav

Ravindra

et al. 2016

Indian J Surg Oncol

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“…We concluded that the major reasonfor pinch-offwas caused by the compression of a catheter between the first rib and clavicles. It is observed in 1.1-5.0% of cases [6][7][8]. The complication of resistance causes myocardial or intravascular perforation, arrhythmia, endocarditis, pulmonary artery thrombosis or embolization and sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…There wasa rare of 2.1% of complete occlusion in our institute.Kurul reported a catheter tip that rubs against the vein can produce a local thrombosis [14,15]. Nevertheless, precipitation from total parenteral nutrition, drugs, transfusion, or other intravenous solutions as well as particles that come from port membrane, port floor, or cutaneous tissue from punctures can obstruct the device [7,12]. Although we took a chest X-ray and computed tomography, we can carry out to exclude catheter malposition, kinking, disconnection, fracture and migration.…”

Section: Discussionmentioning

confidence: 99%

Attention of Cancer Care for Totally Implantable Venous-access Ports Associate Complications the Latest 6 Years Analysis of 400 Cancer Chemotherapy Patients

Osawa¹,

Takazawa²,

Kameoka³

et al. 2016

Int J Nurs Clin Pract

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“…Although the large variety of catheter complications 3,4,7,8 and their impact on catheter function are well documented in the literature, catheter fragmentation with subsequent embolization is an event reported only sporadically (Table 1; 7,[9][10][11][12][13][14][15][16][17][18][19] ). Reviewing our experience with 763 percutaneously inserted soft silicon catheters (Hickman catheters and implantable port-a-caths) from 1992 to 2000 we identified catheter fragmentation in only the one patient described here (0.13%).…”

Section: Discussionmentioning

confidence: 99%

“…In case of pinchoff syndrome grade 2 it is recommended that the CVC be removed, even when it is functioning normally. 13,14 Only thereby can the serious complication of fragmentation and embolization, possibly necessitaiting costly surgical techniques such as thoracotomy be prevented. 29 To summarize, catheter fragmentation is a rare but dangerous complication of CVC lines.…”

Section: Discussionmentioning

confidence: 99%

Central venous catheter pinch-off and fracture: recognition, prevention and management

Fazeny-Dörner

Wenzel

Berzlanovich

et al. 2003

Bone Marrow Transplant

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Summary:The so-called pinch-off syndrome is observed in up to 1% of all central venous catheters (CVCs), and is a valuable warning prior to fragmentation, which occurs in approximately 40% of the respective cases. As long-term indwelling CVCs are used with increasing frequency, this paper describes the necessity of pinch-off monitoring following the experiences of a case study and a review of the current literature on this specific topic in order to point out preventive practice guidelines.Besides easy preventive practices such as a high level of suspicion and adequate X-ray controls, findings give strong evidence that the most important specific factor might be the adequate approach.In our hands, the supraclavicular technique has provided the best results with regards to percutaneous introduction of large bore CVCs. Central venous catheters (CVCs) are useful therapeutic and diagnostic devices for administration of fluids, chemotherapeutic agents, parenteral nutrition and for central venous pressure monitoring, for vascular access, for extracorporal treatment regimens, and bone marrow transplantation. [1][2][3] As with most invasive procedures, central venous catheterization is associated with numerous potential complications, both during placement and later in long-term maintenance. Pneumothorax, infection, bleeding, arrhythmias, malposition, and thrombosis are well-known complications. 3,4 A rare but serious complication is catheter fragmentation with subsequent embolization through the heart into the pulmonary artery occurring in approximately 40% of patients who develop the possible precursor warnings of catheter fragmentation, the so-called pinchoff sign described by Aitken and Minton in 1984. [5][6][7] As long-term indwelling, CVCs have often become the patient's lifeline and are used with increasing frequency worldwide, we report a representative case of our own experience and summarize the current literature on this specific topic in order to emphasize preventive practice guidelines. Case reportA 35-year-old female presented with acute lymphatic leukemia in 1988. After treatment with standard chemotherapy she achieved complete remission. After 4 years, she relapsed and required reinduction. Prior to reinduction a port-a-cath was inserted by surgical cut-down technique. After chemotherapy the patient was scheduled for autologous bone marrow transplantation. Since the treating physicians considered an additional long-term device necessary for autologous bone marrow transplantation a double-lumen Hickman-catheter (Bard 12.0 Fr, Round Dual Lumen; Cranston, RI, USA) was inserted by surgical cut-down to access the contralateral subclavian vein. The procedure was performed by the surgeons without complications. The slight kinking of the line on the postprocedural chest radiograph was accepted because the catheter lines were functioning, the catheter tip was positioned correctly and the lumina of both catheter lines were inconspicious.Conditioning chemotherapy was administered and was followed by bone marrow tra...

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Catheter fracture: A rare complication of totally implantable subclavian venous access devices

Cited by 79 publications

References 5 publications

Totally Implantable Venous Access Devices in Children Requiring Long-Term Chemotherapy: Analysis of Outcome in 122 Children from a Single Institution.

Totally Implantable Venous Access Devices in Children Requiring Long-Term Chemotherapy: Analysis of Outcome in 122 Children from a Single Institution.

Attention of Cancer Care for Totally Implantable Venous-access Ports Associate Complications the Latest 6 Years Analysis of 400 Cancer Chemotherapy Patients

Central venous catheter pinch-off and fracture: recognition, prevention and management

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