Pinch-off Syndrome Research Articles

14 Yıllık Bir Port Kateterin Sık Karşılaşılmayan Komplikasyonu

Percutaneous subclavian catheters or port-catheters are commonly used for oncology patients who require long-term or continuous intravenous therapy. There are several reported complications related to port-catheters like arterial puncture, pneumothorax and hematoma. We aimed to report an unusual port-catheter case. Our patient was a 45-year-old male who had a port-catheter inserted after the diagnosis of rectum cancer in 2009 and has never showed up for a catheter removal after his chemotheraphy regimen had been completed. The silicone port of the catheter was found to be disintegrated during the catheter removal procedure. Removal was performed but distal 5 cm of the catheter was missing. At the end of the procedure, control X-ray was obtained , but the last part of the catheter could not be visualized. There are reported cases of pinch-off syndrome in the literature however we couldn’t find any such case as we report. Following port-catheter implantation and throughout the course of treatment, patients should be consistently monitored, and an appropriate time should be scheduled for removal. Physicians should be aware of complications and multidisciplinary approaches should be made to avoid serious events and further harm. Keywords: Port-catheter complication, port-catheter removal, port-catheter detachment, pinch-off syndrome

Ultrasound-guided totally implantable venous access ports placement via right brachiocephalic vein in pediatric population: A clinical debut.

To investigate the feasibility and safety of ultrasound-guided totally implantable venous access ports (TIVAPs) via the right brachiocephalic vein (BCV) in pediatric patients. A single-institute retrospective review was performed on 35 pediatric patients with predominantly hematological malignancies (88.6%) who underwent TIVAP implantation via ultrasound-guided right BCV approach from July 2018 to June 2021. The catheter tip was adjusted to be positioned at the cavoatrial junction under pulsed fluoroscopic guidance. Technical success rate, procedural information, and TIVAP-related complications were evaluated. All the pediatric TIVAP devices were successfully implanted via right BCV access. Venous access was successful by first attempt in 32 children (91%), two cases (5.7%) required a second attempt, and one patient (2.9%) required a third attempt. The mean procedural time was 44.6 ± 6.4minutes (range: 34-62minutes). No intraoperative complications occurred. The average TIVAP indwelling time was 564 ± 208days (range: 193-1014days), with a cumulative 19,723catheter-days. Overall, three patients (8.6%) experienced four postoperative complications (two cases of local hematoma and two catheter dysfunctions) at a rate of 0.2 per 1000catheter-days. No other complications such as wound dehiscence, delayed incision healing, catheter-related thrombosis (CRT), catheter malposition/fracture, surgical site infection, catheter-related bloodstream infection (CRBSI), pinch-off syndrome, and drug extravasation were observed during follow-up. Ultrasound-guided right BCV access for TIVAP placement in pediatric patients appears to be technically feasible, safe, and effective. Further large-sample, prospective studies are warranted.

A delayed complication of a port-a-cath insertion via subclavian venous access: Case report of a "pinch-off syndrome".

IntroductionPort-a-caths are long-stay central catheters often used for chemotherapy or parenteral nutrition. The implantation of a port-a cath, despite being involved in routine procedures, is also associated with immediate and delayed complications. Complications are rare but must be known and managed by operators.Case reportA delayed complication related to the presence of a port-a-cath, consisting in the fragmentation of the catheter, has been reported, in a 63-years-old female patient. The port was placed via subclavian venous access and affected by pinch-off syndrome, which resulted in catheter malfunction and then in fragmentation from compression by the subclavius-costoclavicular complex. The onset symptom was device malfunction.Discussion and conclusionThe focus in the management of this rare but possible complication was the quick removal of the device and of the catheter fragment in the endovascular lumen with collaboration between different medical specialists.

Totally implantable venous access device fracture due to pinch-off syndrome

Fracture and migration of totally implantable venous access devices is a rare but potentially serious complication. Pinch-off syndrome was described in subclavian venous accesses when the intermittent compression of the catheter between the first rib and the clavicle produces catheter fracture. The report the case of a patient with cancer who underwent implantation of a totally implantable venous access device through the subclavian vein under ultrasound and radioscopy guidance. After several cycles of chemotherapy, the patient started with malfunctioning of the device. The chest X-ray showed a complete fracture of the catheter at the level of the costoclavicular space with migration of a fragment of the catheter to the right cardiac chambers. The fractured catheter was percutaneously removed via the right femoral vein using nitinol gooseneck snare without complications. The incidence of the pinch-off syndrome, risk factors and prevention measures in totally implantable venous access devices are analyzed.

Detachment and embolization of totally implantable central venous access devices: diagnosis and management

Background Detachment and embolization (DE) is a rare complication of totally implantable central venous access devices (TIVADs). This study aimed to analyze clinical findings, etiology, and treatment options in DE of TIVADs. Methods Patients who experienced DE between 2010–2019 were included. Indications, implantation techniques, time to diagnosis, patient complaints, diagnostic methods, rupture site, location of embolization, treatment methods, and chest X-rays prior to detachment were analyzed retrospectively. Results DE of TIVAD was detected in 12(1.2%) patients. Eleven patients had breast cancer and one had colon cancer. Mean age at implantation was 45.3 ± 9.6(31–61.3) years. Seven (58%) patients were asymptomatic, four (33.3%) had TIVAD malfunction, and one (8.3%) had pain and swelling at port site after injection. Mean time from implantation to diagnosis was 1149.92(16–2795) days. The etiologies comprised Pinch-off Syndrome (POS) in eight (66%) patients, detachment directly adjacent to the lock mechanism in three (25%) patients, and probable iatrogenic injury during explantation in one (9%) patient. The most common site of embolism was the superior vena cava (25%). While the embolized fragment was removed percutaneously in 11 patients, medical follow-up was treatment choice for one patient. Conclusions DE is a rare complication with an incidence rate of 1.2% in this study. Since most patients were asymptomatic, chest radiography plays an important role in diagnosis. The most common cause was POS, and it can be prevented by inserting the catheter from lateral third of the clavicle during subclavian vein catheterization. The first-choice treatment was percutaneous femoral retrieval. However, if not technically possible, alternative treatment options are thoracotomy or follow-up with anticoagulant therapy.

Fracture and embolization of an implantable venous access device in patient with atrial septal defect

Totally implantable venous access devices (TIVADs) are frequently used for the administration of chemotherapy or parenteral nutrition and have proved to be safe and improve patient quality of life during treatment. Catheter-related infections are the most common complication, whereas catheter fracture and embolization is rarely seen. We present a case of a 61-year-old cancer patient in which the TIVAD fractured and embolized to the patient’s left knee 18 months after its initial placement. An endovascular procedure with intraoperative imaging revealed that the catheter had embolized to the popliteal artery and was successfully removed, the only explanation being the presence of an atrial septal defect. A bubble echocardiogram was unsuccessful in confirming the diagnosis. The catheter fracture could be related to an intravascular procedure that was performed 18 months prior to remove fibrin sheaths as a cause of port malfunction, or it could be a case of pinch-off syndrome.

Application of transesophageal echocardiography for localization in totally implantable venous access port implantation through subclavian approach in children.

A totally implantable venous access port (TIVAP) is important in children who need intravenous infusion for a long time. A number of studies have shown methods for locating the tip of the TIVAP catheter. To explore whether transesophageal echocardiography (TEE) can be used to accurately locate the TIVAP catheter tip through a subclavian approach and to improve the rate of correct TIVAP catheter placement and reduce complications of TIVAP placement. In 36 children who needed TIVAP implantation surgery, we used real‐time TEE guidance to place the catheter tip around the crista terminalis. In all children, chest X‐rays were used to figure out whether the catheter tip as localized by TEE was within the T5‐T7 segment. Then, we compared the length of the catheter calculated by the height formula and the actual catheter length applied under TEE guidance. The medical records, surgical details, nursing records, and recorded complications were collected during the follow‐up. The success rate of TIVAP implantation was 100% in all enrolled patients and no hemopneumothorax or pinch‐off syndrome occurred. Compared with TEE, chest X‐ray showed a coincidence rate of 80.56% in correctly detecting the TIVAP catheter tip locate. The height‐derived catheter length (11.0 [9.6, 11.8]) cm and the TEE‐derived catheter length (10.0 [9.3, 10.8]) cm were significantly different (p < .001). TEE can be used to guide TIVAP catheter positioning through a left subclavian approach in children accurately and successfully and more accurate than chest X‐ray and height calculation formula.

Prospective Audit to Study urokinaSe use to restore Patency in Occluded centRal venous caTheters in haematology and oncology patients (PASSPORT 2).

Central venous catheter dysfunction may be associated with intraluminal clots, drug precipitates and lipid residues or extra luminal causes such as fibroblastic sleeve, tip malposition, pinch-off syndrome and venous thrombosis at the tip of central venous catheter. Failure to restore patency after addressing these causes, empirical treatment with thrombolytic agents should be considered. Urokinase is used widely as a thrombolytic agent but very few outcome studies have been published. A multicentre group conducted a prospective audit of management of central venous catheter dysfunction after exclusion of common causes using in centre standardised doses of urokinase from September 2017 to February 2018 in haematology and oncology units. Data of catheter blood flow were collected anonymously following administration of 5000- to 25,000-IU urokinase in dysfunctional central venous catheter. A total of 117 patients were recruited from eight centres, 54 females and 63 males, median age was 60 (46-68). In total, 53% presented as partial withdrawal occlusion and 47% total occlusion. In partial withdrawal occlusion, patency was restored in 80% of interventions, in 82% of interventions using push lock and in 76% using dwell lock. In total occlusion, patency was restored in 88% of the interventions. The central venous catheter clearance rate was dose dependent; patency was restored in 83% of central venous catheter with 5000 IU, 89% with 10,000 IU and 92% with high dose of 25,000 IU. No adverse events were recorded. In this study, treatment of dysfunctional central venous catheter using standardised urokinase doses was safe and effective in restoring patency when no other mechanical causes could account for central venous catheter dysfunction.

Causes of Fracture at Catheter of Totally Implantable Venous Access Port: A Systematic Review

A totally implantable venous access port (TIVAP) plays a crucial role in the treatment of patients in oncology. Catheter fracture is a serious complication with an estimated incidence of 0, 1% - 1%. The objective of this systematic review is to analyze the mechanism of TIVAP fracture to make physicians aware of this fatal entity. A search of the literature between 1980 and 2019 was conducted using PubMed, Ovid, MEDLINE, and Cochrane Systematic Review databases. The search identified 18 case reports and 8 retrospective studies. Fracture of the middle part of the catheter may be induced by constant compression of the catheter between the first-rib and clavicle, which is called the pinch-off syndrome. Catheter fracture at the port-catheter junction may be caused by extrinsic compression near the port-catheter junction combined with material fatigue due to repeated bending of the catheter with shoulder movement. There is no specific cause for the fracture of a catheter tip. An annual chest X-ray is recommended for the early detection of TIVAP catheter fracture. Percutaneous endovascular retrieval of a dislodged Port-A catheter is both safe and effective. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2020;57(12):686-689.

Surgical treatment of pinch-off syndrome: A hybrid technique combining cone-beam computed tomography-guided targeting and surgical removal of catheter remnant

Abstract Pinch-off syndrome is a rare complication associated with central venous catheters in which the tip of the catheter breaks off, usually in the cardiac chamber or pulmonary artery. Because the catheter tip can induce embolization, it is essential to remove it in these cases. An interventional technique is usually preferred over surgical removal due to the risk of surgery in pediatric patients. However, we present here the successful removal of a catheter tip from the distal pulmonary artery using a hybrid technique combining cone-beam computed tomography-guided targeting with surgical removal.

Analysis of one case of game related PICC catheter rupture and nursing care

Objective To study the cause of 1 PICC catheter rupture, and discuss the nursing interventions. Methods Comprehensive analysis was carried out on the review of the use and maintenance of PICC catheter, patient's life style and catheter quality test. Results The main reasons of PICC catheter rupture were the pinch-off syndrome and catheter plug caused by gaming disorders and non-canonical maintenance of PICC outhospital. Conclusions With the growing of video game players, gaming disorder may be one acquired factor of PICC catheter rupture. To reduce the occurrence of PICC catheter rupture, prompt identification of and timely intervention to gaming disorder and intensified outhospital care are paramount. The predictive diagnostic tests of catheter ectopia based on clinical syndromes, physical signs and catheter state, are helpful for the early recognition and treatment of PICC catheter rupture, followed by the risk reduction of pulmonary embolism. Key words: Game disorder; PICC catheter; Fracture; Nursing care

Treatment of Canine Multicentric Lymphoma Through Vascular Access Port Versus Peripheral Venous Catheter

Background: Vascular access port (VAP) was developed for the administration of chemotherapeutic agents, minimizing local drug reactions and complications associated with migration of peripheral venous catheter (PVC) in humans. The device is widely used in human oncology and has gained importance in veterinary oncology, especially in long treatment regimens, as in the case of canine lymphoma. VAP favors therapy and the animals’ quality of life. The aim of this study was to describe the use of VAP in dogs, comparing to PVC access, during canine lymphoma chemotherapeutic treatment. Materials, Methods &amp; Results: Eleven dogs with multicentric lymphoma which required chemotherapy were selected for the study. The dogs were randomly allocated to two groups with five and six animals, and each group received the chemotherapy protocol through the PVC (n= 5) or VAP (n= 6). For the sake of standardization, assessments were made whenever the dogs received vincristine sulfate, despite the use of the infusion system in all sessions of the Madison-Wisconsin protocol. A VAP was implanted into the right external jugular vein of six dogs under inhalational anesthesia, using the Seldinger technique. Systolic blood pressure (SBP) levels and handling time during chemotherapy sessions were compared in both groups in three time periods during the procedures: 10 min after arrival to each chemotherapy (P1); immediately after placement of the PVC or puncture of the VAP reservoir (P2); and at the end of chemotherapy (P3). The arithmetic mean of five consecutive assessments was used in each time period. In the chemotherapy sessions, the mean of SBP variation decreased statistically significant in the VAP group compared to PVC group. SBP decreased from P1 to P2 and from P1 to P3 in all sessions (S1, S2, and S3) in the VAP group, and increased in the PVC group. The handling time of VAP group was 110.6 ± 8.4 s, compared to 219.2 ± 24.7 s (mean ± standard error) in the PVC group, showing statistically significant difference (P &lt; 0.001). VAP surgical implantation time averaged 37 min, decreasing gradually from the first (55 min) to the last patient (21 min).Discussion: SBP levels suggest that the VAP group was calmer from the beginning to the end of the sessions, showed lower SBP levels, and required shorter handling time than did the PVC group. Blood pressure is one of the most objective ways to assess welfare or stress in dogs. When dog feels threatened or scared, its body automatically enters a state of emergency and, among several changes, blood pressure increases. VAP surgical implantation in dogs have easy learning, as previously described, proven by implantation time progressive reduction. The Seldinger technique is the method of choice for catheter implantation in humans. Dissection of the jugular vein is an alternative, however, the technique with a single incision and venipuncture is less invasive than its modifications. The jugular vein was used because is the site of choice for central accesses in veterinary practice, with a shorter path to the right atrium and smaller rates of catheter misplacement, reducing the risk of pneumothorax, venous thrombosis, and pinch-off syndrome. VAP surgical implantation in dogs have easy learning, proven by the implantation time progressive reduction. The study confirmed that VAPpromoted animal welfare, shortened chemotherapy sessions, and caused less discomfort to dogs treated for multicentric lymphoma, as indicated by the reduction in SBP, when compared to the PVC group.

Pinch-off syndrome: a rare and serious complication of central venous catheters

A 60-year-old woman with stage IIIC invasive squamous cell carcinoma of the anal canal underwent implantation of the left subclavian venous access device in preparation for administration of concurrent chemotherapy...

Complications and management strategies of totally implantable venous access port insertion through percutaneous subclavian vein.

The aim of this study was to present clinical characteristics, peri-procedural outcomes, early and late complications, and management strategies in patients undergoing totally implantable venous access port insertion through percutaneous subclavian vein. A total of 2,084 port devices were inserted to 2,000 cancer patients (1,066 males, 934 females; mean age 58.4±12.7 years; range, 18 to 88 years) through subclavian vein using percutaneous landmark method between March 2012 and June 2018. Medical data including demographic features, primary diagnosis, technical success, procedural time, duration of device use, reasons for the device removal, and early and late complications were retrospectively analyzed. The most common type of cancer was colon cancer in males and breast cancer in females. Technical success rate of the procedure was 98.5%. Right subclavian vein was accessed in the majority of patients (92.4%). Early complications including inadvertent arterial puncture, catheter malposition, superficial hematoma, and pneumothorax occurred in 143 patients (6.9%), while late complications including infection, catheter occlusion, venous thrombosis, wound problems, catheter migration and embolization and pinch-off syndrome was developed in 118 patients (5.7%). Inadvertent arterial puncture in 63 patients (3%) was the most common early complication, while infection in 44 patients (2.1%) was the most common late complication. A total of 192 devices were removed due to the completion of chemotherapy or development of complications. Our study confirmed the safety and tolerability of totally implantable venous access port insertion through percutaneous subclavian vein with high technical success and low complication rates.

Totally implantable central venous port: analysis of complications and their prevention

To analyze postoperative complications of totally implantable central venous port system (TIPCVP) deployment and develop methods of their prevention. The study involved 43 patients who underwent TIPCVP implantation through right-sided jugular access and 3 patients with migration of the catheter transferred to the Domodedovo Central City Hospital. There were four perioperative and one early postoperative complication. None of the complications was the reason for removal of TIPCVP. Pinch-off syndrome occurred in two patients who were operated in other hospitals and a catheter was inserted through the right subclavian vein. Injury of the carotid artery and pneumothorax can be avoided by ultrasound navigation during internal jugular vein puncture. Catheterization of the internal jugular vein is useful to avoid pinch-off syndrome. Migration of the catheter is successfully cured by endovascular methods.

Hairpin coiling of central line catheter: Pinch-off syndrome?

Central line insertion is a commonly performed procedure in the intensive care unit. Although technical difficulty is moderate, experience decreases the failure rate. Central vein catheter (CVC) insertion is associated with various complications such as pneumothorax and arterial puncture, but rare possibilities such as coiling of catheter can still occur and every intensivist should be cautious about it. Chest X-ray remains the gold standard to confirm the course and position of CVC and should be correlated with clinical findings. We report a case where CVC insertion was associated with coiling and led to occlusion of the proximal port.

Pinch-off syndrome ou syndrome de la Pince Costo-Claviculaire

Implantable catheter systems are the most common procedure used for patients requiring chemotherapy or long-term drug administration. Several procedures are used for the installation of these systems. Patients with long-term subclavian venous catheters described a progressive rupture of the catheter which is a rare complication. This rupture is most often due to costoclavicular forceps or Pinch-off syndrome (POS). We report 07 cases of Pinch-off syndrome to evaluate our diagnostic and therapeutic approach.

Pinch-Off Syndrome and Fracture Embolization: a Preventable Complication of TIVADS.

Totally implantable venous access device has become indispensable in oncology. One of the well-known complications of the subclavian approach is the pinch-off syndrome. We hereby describe how a case of pinch-off syndrome with catheter fracture and embolization into the heart was managed by prompt endovascular intervention.

Pinch-Off Syndrome, a Rare Complication of Totally Implantable Venous Access Device Implantation: A Case Series and Literature Review.

BackgroundPinch-off syndrome (POS) is a rare complication after totally implantable venous access device (TIVAD) implantation. In cancer patients, it is important to prevent this rare complication and to recognize it early if it does occur. We present a case series of POS after TIVAD implantation and the results of a literature search about this complication.MethodsFrom July 2006 to December 2015, 924 permanent implantable central venous catheter implantation procedures were performed. The most common indication was vascular access for chemotherapy.ResultsPOS occurred in 5 patients in our clinic. Two patients experienced POS within 2 weeks, and the other 3 patients were admitted to department of surgery, Istanbul Faculty of Medicine at 6 to 14 months following implantation. The catheters were found to be occluded during medication administration, and all patients complained of serious pain. The transected fragments of the catheters had migrated to the heart. They were successfully removed under angiography with a single-loop snare.ConclusionPOS is a serious complication after TIVAD implantation. It is important to be aware of this possibility and to make an early diagnosis in order to prevent complications such as drug extravasation and occlusion events.

Port-a-Cath™ partial rupture in a low-grade pinch-off syndrome

Port-a-Cath™ partial rupture in a low-grade pinch-off syndrome