Faculty Collaboration Database

Pinch-off syndrome: a rare etiology for central venous catheter occlusion. JPEN J Parenter Enteral Nutr 1994;18(6):531-3

Date

11/01/1994

Pubmed ID

7602729

DOI

10.1177/0148607194018006531

Scopus ID

2-s2.0-0028081785 (requires institutional sign-in at Scopus site)   87 Citations

Abstract

BACKGROUND: Catheter pinch-off syndrome is a rare and often misdiagnosed complication of tunneled Silastic central venous catheters. Pinch-off syndrome occurs when the catheter is compressed between the first rib and the clavicle, causing an intermittent mechanical occlusion for both infusion and withdrawal. We report its incidence in a large series of catheter insertions and describe the clinical presentation, radiographic findings, and recommended treatment.

METHODS: A total of 1457 tunneled Silastic central venous catheters that were inserted using the percutaneous subclavian approach were prospectively studied. Indications for catheter placement included bone marrow transplant, continuous or intermittent chemotherapy, long-term antibiotics, and parenteral nutrition. Catheters were evaluated for clinical presentation of an occlusion relieved by postural changes and radiographic findings of luminal narrowing.

RESULTS: Pinch-off syndrome was identified in 16 (1.1%) catheters. Radiographic findings were present in all catheters; clinical findings were present in 15 catheters. Clinical symptoms presented within a median of 2 days after placement (range, 0 to 167 days). Partial or complete catheter transection, a serious sequela of catheter pinch-off syndrome, occurred in 19% of the identified catheters.

CONCLUSIONS: (1) Catheter pinch-off syndrome presents clinically as a catheter occlusion related to postural changes; (2) clinical symptomatology should be confirmed radiographically; and (3) catheter removal with a more lateral replacement in the subclavian vein or in the internal jugular vein will avoid a recurrent complication.

Author List

Andris DA, Krzywda EA, Schulte W, Ausman R, Quebbeman EJ

Author

Edward J. Quebbeman MD Emeritus Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-Bacterial Agents
Antineoplastic Agents
Bone Marrow Transplantation
Catheterization, Central Venous
Constriction
Equipment Failure
Humans
Jugular Veins
Parenteral Nutrition, Home
Posture
Prospective Studies
Radiography
Subclavian Vein