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Hickman catheter separation
Insights
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.
- 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.
Abstract:
Seven patients with Hickman/Broviac catheters implanted via the percutaneous subclavian route are reported to have had catheter separation and embolization; one catheter implanted via cephalic vein cutdown also separated. The method of percutaneous subclavian catheter insertion is briefly described, and the mechanism of catheter separation is discussed. Percutaneous insertion routes the silicone catheter between the clavicle and first rib, producing compressive/shearing force which can cause the catheter to break--usually after several months. Embolized catheter fragments can be retrieved with a percutaneous transfemoral venous snare. The described complication represents a 1% incidence. Recommendations to minimize this problem include: placement of subclavian puncture at or lateral to midclavicular line; chest x-rays at 2- to 3-month intervals to identify catheter indentation at the thoracic inlet; early removal of catheters for patients with radiologic evidence of significant catheter compression.