The mechanisms of positional dysfunction of subclavian venous catheters.
OBJECTIVE
To determine the origin of subclavian vein catheter and lead dysfunction.


METHODS
Cineradiography was performed on 10 patients with subclavian venous catheter dysfunction and three patients with pacemaker or defibrillator lead dysfunction. The leads and catheters were removed and replaced with use of a fluoroscopically guided technique; the needle entered the vein lateral to the first rib. Repeat cine examinations were performed following placement of new catheters.


RESULTS
The cause of the dysfunction of all 10 catheters was shown to be pinch by the subclavicular musculotendinous tissues as the catheter passed below the clavicle toward its entry into the vein. All three leads were entrapped in the subclavicular tissues and stretched during abduction. The abnormal motion and clinical problems were eliminated after replacement.


CONCLUSIONS
Subclavian catheter and lead malfunction is not due to compression between the first rib and the clavicle. It is due to entrapment in the subclavius muscle-costoclavicular ligament complex, which binds or compresses the device during movements. These problems can be avoided by employing fluoroscopically guided puncture techniques that enter the vein lateral to the first rib.
Krutchen
A E
AE
Department of Radiology, University of Minnesota Hospital and Clinic, UMHC, Minneapolis 55455, USA.
Bjarnason
H
H
Stackhouse
D J
DJ
Nazarian
G K
GK
Magney
J E
JE
Hunter
D W
DW
D002405:Catheterization, Central Venous; D002933:Cineradiography; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D011312:Pressure; D015641:Radiography, Interventional; D013350:Subclavian Vein