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Hickman catheter separation.

R B Rubenstein, R E Alberty, L G Michels

    JPEN. Journal of Parenteral and Enteral Nutrition
    |November 1, 1985
    PubMed
    Summary
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    Hickman/Broviac catheters inserted via the subclavian vein can break due to compression between the clavicle and first rib. Retrieval of embolized fragments is possible, and early detection via X-ray can prevent this complication.

    Area of Science:

    • Vascular Surgery
    • Medical Device Complications
    • Interventional Radiology

    Background:

    • Hickman/Broviac catheters are commonly used for long-term venous access.
    • Percutaneous subclavian insertion is a frequent method for placing these catheters.
    • Catheter separation and embolization are known but infrequent complications.

    Observation:

    • Seven cases of catheter separation and embolization occurred in patients with percutaneous subclavian implanted Hickman/Broviac catheters.
    • One catheter implanted via cephalic vein cutdown also separated.
    • Catheter failure typically occurs after several months of use.

    Findings:

    • The mechanism involves compressive and shearing forces on the silicone catheter as it passes between the clavicle and first rib.

    Related Experiment Videos

  • This complication has an estimated incidence of 1%.
  • Embolized catheter fragments can be successfully retrieved using a percutaneous transfemoral venous snare.

    • Implications:

    • Optimizing subclavian puncture site (at or lateral to the midclavicular line) may reduce risk.
    • Regular chest X-rays (2-3 month intervals) can detect catheter indentation at the thoracic inlet.
    • Early catheter removal in cases of significant compression is recommended to prevent separation and embolization.