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Published on: June 12, 2021
A rare complication of implanted central-venous access devices: catheter fracture and embolization
J M Debets1, J A Wils, J T Schlangen
1Department of General Surgery, St. Laurentius Ziekenhuis, CV Roermond, The Netherlands.
Summary
Totally implanted central-venous access devices can fracture, a rare complication. This occurs due to compression between the clavicle and first rib, potentially leading to fragment embolization to the heart or pulmonary vessels.
Area of Science:
- Vascular Surgery
- Medical Device Complications
- Radiology
Background:
- Totally implanted central-venous access devices are crucial for chemotherapy and parenteral nutrition delivery.
- Catheter fracture is a rare but serious complication associated with these devices, occurring in approximately 0.1% of cases.
Observation:
- Three recent cases of catheter fracture with subsequent embolization of fragments to the heart and pulmonary vasculature were observed.
- Catheter fracture is often caused by intermittent compression between the clavicle and first rib, particularly with medial insertion.
Findings:
- Radiographic evidence of catheter compression at the clavicle-first rib junction is a strong indicator of potential fracture.
- Sudden difficulty with infusion through the device also suggests a high risk of catheter fracture.
Implications:
- Early recognition of these signs is critical for timely intervention.
- Prompt removal of the device is recommended when catheter fracture is suspected to prevent serious complications like embolization.
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