Early Rupture of Subclavian Vein Catheter: A Case Report and Literature Review

Abstract

Prolonged venous access devices (PVADs) have become indispensable in antiblastic protocols for the treatment of cancer patients, in anti-infection protocols for acquired immunodeficiency syndrome (AIDS) patients and in the management of chronic malabsorption syndromes. Using these catheters carries the risk of several complications, and some are potentially lethal, for example, cardiac embolization of catheter fragments. Rupture is a complication almost exclusive to catheters positioned percutaneously: after using this technique, device malfunction can occur due to catheter kinking after its excessively medial introduction in the subclavian vein. The early recognition of any pinch-off sign (POS) is fundamental in preventing catheter rupture that frequently follows this complication. Other factors can be involved in early rupture, for example, excessive force on a syringe used to clear a catheter that shows early signs of malfunction, or a strength defect in the materials used in the catheter construction. This report describes an early rupture case of an initially correctly positioned catheter and reviews 20 such cases in the recent literature.

Approach to Fragmented Central Venous Catheters

“…10 Sarzo and colleagues suggested that the catheter is enveloped by a fibrin sleeve right after the implantation and caused an antireflux valve mechanism, preventing blood collection or treatment infusion. 12 The catheter wall is weakened by repeated attempts to clear the catheter by applying an excessive force on the syringe plunger, and this could explain the cases of catheters fragmenting shortly after their implantation.…”

“…9,10 Fragmentation may have more than one cause. 11,12 Aitken and Minton defined “pinch-off sign” as friction of a catheter positioned too medially between the clavicle and the first rib. 11 The catheter narrows owing to the mechanical compression in the costoclavicular passage.…”