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[The pinch-off syndrome: main cause of catheter embolism]
B Ouaknine-Orlando1, E Desruennes, M F Cosset
1Département anesthésie-analgésie-réanimation, Institut Gustave-Roussy, Villejuif, France.
Objective:
To assess the incidence of the pinch-off syndrome (POS) in catheter fracture and embolism.
Study Design:
Retrospective clinical study.
Patients:
The medical files of 56 patients who had since 1989 an embolized fragment or entire catheter removed by an interventional radiologic procedure have been retrospectively analysed.
Methods:
A POS was considered the causative factor when a chest X-ray showed a rupture of the catheter at the site of the costoclavicular space.
Results:
From 1989 to the end of 1996, 56 catheter embolisms by fracture or disconnection occurred in our institution. The rupture from a POS was the main cause of embolism (24 patients out of 56). The incidence was 8/1000 of implanted ports inserted via a subclavian access [95% confidence interval: 4/1000-13/1000]. Preliminary clinical or radiologic signs of pinching existed in 50% of POS: difficult insertion, radiologic compression aspect, arm or shoulder pain, infusion rate and/or reflow depending on arm position.
Conclusions:
POS was the first cause of catheter embolism and should suggest the use of an alternative way for insertion instead of the subclavian access. When a catheter is inserted via a subclavian route, clinical and/or radiologic signs of POS require its removal.