Costoclavicular pinching: a complication of long‐term central venous catheters: A report of three cases

Abstract

In the course of 1994-1995 we found three nearly identical cases involving fracture of polyurethane catheters from subcutaneous implantable vascular ports. This resulted in complications: leakage of drugs and infusions and thereby soft tissue damage. The leakage occurred in the costoclavicular space in all instances. We assume that the catheters have been subjected to repeated pinching, resulting in material fatigue. In order to eliminate the risk of this serious complication, the subclavian route should be avoided and preference given to the approach via the internal jugular vein.

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

“…Regarding delayed complications, fragmentation of central venous catheters placed via the subclavian venous route is a rare and often late occurring complication. The catheter component, in fact, courses between the costoclavicular ligament and subclavius muscle at the level of the first rib and clavicle, giving rise to the pinch-off syndrome [7] , [8] .…”

Spontaneous Fracture and Embolization of Port-a-Cath placed Via Subclavian Venous Access: A Case Report

“…Fragmentation of central venous catheters placed via the subclavian venous route is a rare often late occurring complication [2,3]. Historically, the subclavian vein has been the preferred route for placement of central venous catheters such as port-a-caths secondary to use of reliable anatomical landmarks to facilitate swift successful nonequipment dependent venous access [4].…”

“…The placement of a port is considered low to medium risk with complications occurring early (<30 days) and late (>30 days). Pinch-off syndrome, which is a rare and characteristically late occurring complication of port-a-caths, are unique to those placed via a subclavian venous access [2]. The purpose of this article is to describe a case of pinch-off syndrome, namely spontaneous fracture and embolization of a port-a-cath placed via a subclavian venous access.…”

Internal jugular vein versus subclavian vein as the percutaneous insertion site for totally implantable venous access devices: a meta-analysis of comparative studies

“…The pinch-off syndrome is specifically associated with the SCV approach [ 54 ]. Due to the compression of an implantable port between the clavicle and the first rib, the pinch-off syndrome can result in mechanical compression and shearing forces on the catheter lines [ 55 ], which may lead to malfunction, damage, and even fracture of the catheter after material fatigue [ 56 ], with embolization in the lung vascular bed. Pinch-off syndrome serves as a warning prior to catheter fracture, a rare but serious complication [ 57 ].…”