J Korean Surg Soc.  2013 Sep;85(3):139-144. 10.4174/jkss.2013.85.3.139.

Pinch-off syndrome

• Cho JB
• Park IY
• Sung KY
• Baek JM
• Lee JH
• Lee DS

• KMID: 1426347
• DOI: http://doi.org/10.4174/jkss.2013.85.3.139

Abstract

Subclavian venous catheterization was previously frequently performed, but because of life-threatening complications such as hemothorax, pneumothorax, mediastinal hematoma, and myocardial injury, its use has become less common. However, this practice has some advantages in patient mobility, secured dressing, and rapidity and adequacy of vascular access. In some situations where patient comfort is an especially important consideration, such as with totally implantable venous port insertion for chemotherapy, the subclavian route can be a good choice if an experienced and well-trained faculty is available. The authors have had recent experience with pinch-off syndrome-in other words, spontaneous catheter fracture-in 3 patients who had undergone venous port implantation through the right subclavian route. Through these cases, we intend to review the dangers of subclavian venous catheterization, the causes of pinch-off syndrome, and its clinical presentation, progress, treatments, and prevention.

Keyword

Pinch off syndrome; Subclavian venous catheterization; Spontaneous catheter fracture; Implantable venous port

MeSH Terms

Bandages
Catheterization
Catheters
Hematoma
Hemothorax
Humans
Pneumothorax

Figure

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  Fig. 1 (A) Chest X-ray showed deviated central venous catheter between clavicle and first rib representing pinch-off sign grade 1. (B) Close up view.

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  Fig. 2 Chest X-ray showed fractured central venous catheter and embolization of distal portion of the catheter.

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  Fig. 3 Flouroscopic guided foreign body removal.

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  Fig. 4 Chest X-ray showed remnant catheter.

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  Fig. 5 (A) Chest X ray showed deviated central venous catheter between clavicle and first rib representing pinch-off sign grade 1. (B) Close up view.

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  Fig. 6 Flouroscopic guided foreign body removal.

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  Fig. 7 Chest X-ray showed no deviation or luminal narrowing of central venous catheter representing pinch-off sign grade 0.

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  Fig. 8 Chest X-ray showed inserted left subclavian venous port and foreign body on left lung field.

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  Fig. 9 (A) Chest X-ray showed luminal narrowing of central venous catheter representing pinch-off sign grade 2. (B) Close up view.

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  Fig. 10 Pulmonary arteriography showed transected catheter located inside pulmonary artery.

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  Fig. 11 Flouroscopic guided foreign body removal.

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