Central venous catheter "pinch-off" and fracture: a review of two under-recognized complications

Although uncommon, "pinch-off syndrome" and catheter fracture are reported complications of central venous catheters (CVCs). Pinch-off syndrome is characterized by intermittent catheter malfunction in conjunction with radiologic evidence of catheter compression. Warning signs of pinch-off syndrome include difficulty with-drawing blood samples and resistance to infusion of IV fluids. CVC fracture is characterized by migration of the distal catheter fragment through the heart and, often, into the pulmonary artery; it may be accompanied by the sudden onset of chest pain, palpitations, and arrhythmias. Twenty-seven cases of CVC fracture were reviewed, including 22 cases reported in the literature as well as an analysis of 5 cases that occurred at the authors' institution. Among the 22 cases reported in the literature, the average length of time between catheter insertion and fracture was 6.7 months. In 82% of these cases, the fracture occurred at the clavicle/first rib junction, where mechanical friction against the catheter has been well established as the mechanism for most fractures. In 9 of these 22 cases, evidence of catheter compression was noted on chest x-ray prior to fracture. This paper discusses assessment criteria for pinch-off syndrome and catheter fracture, as well as nursing implications regarding the prevention and early detection of these potentially serious complications.