title: Catheter fracture: a rare complication of totally implantable venous devices.
abstract: The use of totally implantable venous devices (TIVDs) has revolutionised the care and quality of life of oncology patients. Although considered to be generally safe, catheter fracture is a rare but serious complication. The 'pinch-off' syndrome is caused by the compression of the catheter between the clavicle and first rib, and may lead to fracture and possible dislocation of the catheter. We report here the case history of two patients with metastatic breast cancer who developed the 'pinch-off' syndrome, first recognised by difficulty in line aspiration and pain during injection of the catheter. In one case, there was complete fracture with migration of the catheter tip to the right pulmonary artery. In both cases, the lines were removed without serious injury to the patient. All patients with TIVDs should be investigated for possible catheter fracture if they develop pain over the superior anterior chest wall and/or there is difficulty or pain during aspiration or injection.
authors.affiliation: Department of Medical Oncology, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK. nick.maisey@rmh.nthames.nhs.uk
authors.forename: N R
authors.initials: NR
authors.lastname: Maisey
authors.forename: N
authors.initials: N
authors.lastname: Sacks
authors.forename: S R D
authors.initials: SR
authors.lastname: Johnston
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008875:Middle Aged; D010690:Phlebography; D018570:Risk Assessment