title: Catheter fracture: a rare complication of totally implantable subclavian venous access devices.
abstract: Catheter fracture represents a rare problem among non-infectious complications following the insertion of totally implantable long-term central venous access systems for the application of chemotherapeutic agents. A literature survey revealed a total incidence of catheter fractures of 0-2.1%. Imminent catheter fracture can be identified radiologically, using different degrees of catheter narrowing between the clavicle and the first rib, called pinch-off sign. Two cases of catheter fracture are described and potential causes are discussed. Recommendations to avoid the pinch-off sign with the subsequent risk of catheter fracture and migration include a more lateral and direct puncture of the subclavian vein. In case of catheter narrowing in the clavicular-first rib angle, patients should be followed carefully by chest X-rays every 4 weeks. Whenever possible, the system should be removed within 6 months following insertion.
authors.affiliation: Department of Surgery, Division of Visceral Surgery, University of Zurich Hospital, Switzerland.
authors.forename: H P
authors.initials: HP
authors.lastname: Klotz
authors.forename: W
authors.initials: W
authors.lastname: Schöpke
authors.forename: A
authors.initials: A
authors.lastname: Kohler
authors.forename: B
authors.initials: B
authors.lastname: Pestalozzi
authors.forename: F
authors.initials: F
authors.lastname: Largiadèr
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary; D002277:Carcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D010610:Pharyngeal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D011859:Radiography; D013350:Subclavian Vein / Q000000981:diagnostic imaging