title: Central venous catheter "pinch-off" and fracture: a review of two under-recognized complications.
abstract: Although uncommon, "pinch-off syndrome" and catheter fracture are reported complications of central venous catheters (CVCs). Pinch-off syndrome is characterized by intermittent catheter malfunction in conjunction with radiologic evidence of catheter compression. Warning signs of pinch-off syndrome include difficulty with-drawing blood samples and resistance to infusion of IV fluids. CVC fracture is characterized by migration of the distal catheter fragment through the heart and, often, into the pulmonary artery; it may be accompanied by the sudden onset of chest pain, palpitations, and arrhythmias. Twenty-seven cases of CVC fracture were reviewed, including 22 cases reported in the literature as well as an analysis of 5 cases that occurred at the authors' institution. Among the 22 cases reported in the literature, the average length of time between catheter insertion and fracture was 6.7 months. In 82% of these cases, the fracture occurred at the clavicle/first rib junction, where mechanical friction against the catheter has been well established as the mechanism for most fractures. In 9 of these 22 cases, evidence of catheter compression was noted on chest x-ray prior to fracture. This paper discusses assessment criteria for pinch-off syndrome and catheter fracture, as well as nursing implications regarding the prevention and early detection of these potentially serious complications.
authors.affiliation: Dan Rudy Cancer Center, Saint Thomas Hospital, Nashville, TN.
authors.forename: C S
authors.initials: CS
authors.lastname: Nace
authors.forename: R J
authors.initials: RJ
authors.lastname: Ingle
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000451:nursing; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing / Q000628:therapy; D011312:Pressure