I recently had a bizzare occurance with an implanted port and I am interested if anyone else has come acroos this. I was called to see a patient because staff was not able to obtain blood return from a port. While assessing the patient she complained of pain in her neck with flushing. She recieved a chest X-ray on admission and the report stated that the tip was in the subclavian vein. Has anyone heard of the tip retracting back into the subclavian vein???
Is anyone aware of any literature that is out there that speaks to Spontaneous Catheter Tip Malposition or Retraction with ports?
Thank you
Yes, I have read about this and know that it is in the literature, just can not quote the article. But in my presentations I refer to this as herniation of the catheter from the vein into the port pocket. Where did the remainder of this patient's catheter go? If it was originally in the superior vena cava and this xray should the tip in the subclavian vein, then the extra catheter length had to go somewhere. Could it be seen in the port pocket?
The literature refers to tip migration as the tip only moving from the SVC usually to the jugular vein. This would be catheter dislodgement as the entire length of catheter would be moving. Or did you see the entire catheter length coiled inside the subclavian? Was this patient on a ventilator? Have CHF? Excessive coughing or vomiting? All of these factors would increase the intrathoracic venous pressure that is known for causing tip migration. Dislodgement is usually related to how the catheter is stabilized.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Sorry, I was not thinking that it did fracture or break. So the entire catheter was coiled in the subclavian vein then a week later it was seen straight with the tip in the SVC, right? This would be an example of catheter tip migration and is probably due to intrathoracic venous pressures. This is a common cause of all catheter migration. What was happening in that week? Was there no need for infusion during this time?
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
The patient ended up with a PIV in her foot!!!!!
I finally connected with one of the nurses and found out that they ended up replacing the port with a new one which is why I saw the second chest x-ray showing placment in the SVC. I still have to connect with the physician who inserted the second port to see what was pulled out exactly.
I am putting together all the particulars on this case for a case review.
Great point. If the original tip was not at the cavoatrial junction or at least the lower third of the SVC, the risk of migration is much greater.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861