A rare complication of implanted central-venous access devices: catheter fracture and embolization

Totally implanted central-venous access devices are frequently used for the administration of chemotherapy or parenteral nutrition. Catheter fracture is a rare complication of these devices, with an estimated rate of 0.1%. We have lately seen three cases of catheter fracture with embolization of a catheter fragment to the heart and pulmonary vessels. These cases are described in this article. Catheter fracture is caused by intermittent compression of the catheter between the clavicula and the first rib, which can occur when the catheter has been inserted too far medially. When, on an X-ray of the chest, the catheter is shown to be compressed at the point where the clavicula crosses the first rib, or when infusion through the device suddenly becomes difficult, the chance of catheter fracture is high and the device should be removed.