Pinch-off syndrome: a rare etiology for central venous catheter occlusion.
BACKGROUND
Catheter pinch-off syndrome is a rare and often misdiagnosed complication of tunneled Silastic central venous catheters. Pinch-off syndrome occurs when the catheter is compressed between the first rib and the clavicle, causing an intermittent mechanical occlusion for both infusion and withdrawal. We report its incidence in a large series of catheter insertions and describe the clinical presentation, radiographic findings, and recommended treatment.


METHODS
A total of 1457 tunneled Silastic central venous catheters that were inserted using the percutaneous subclavian approach were prospectively studied. Indications for catheter placement included bone marrow transplant, continuous or intermittent chemotherapy, long-term antibiotics, and parenteral nutrition. Catheters were evaluated for clinical presentation of an occlusion relieved by postural changes and radiographic findings of luminal narrowing.


RESULTS
Pinch-off syndrome was identified in 16 (1.1%) catheters. Radiographic findings were present in all catheters; clinical findings were present in 15 catheters. Clinical symptoms presented within a median of 2 days after placement (range, 0 to 167 days). Partial or complete catheter transection, a serious sequela of catheter pinch-off syndrome, occurred in 19% of the identified catheters.


CONCLUSIONS
(1) Catheter pinch-off syndrome presents clinically as a catheter occlusion related to postural changes; (2) clinical symptomatology should be confirmed radiographically; and (3) catheter removal with a more lateral replacement in the subclavian vein or in the internal jugular vein will avoid a recurrent complication.
Andris
D A
DA
Medical College of Wisconsin, Department of Surgery, Milwaukee 53226, USA.
Krzywda
E A
EA
Schulte
W
W
Ausman
R
R
Quebbeman
E J
EJ
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D016026:Bone Marrow Transplantation; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D003250:Constriction; D004868:Equipment Failure; D006801:Humans; D007601:Jugular Veins; D016331:Parenteral Nutrition, Home; D011187:Posture; D011446:Prospective Studies; D011859:Radiography; D013350:Subclavian Vein
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents