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dfritz
implanted port catheter fracture

Had an incident on Monday where a 28 y.o. pt with medulloblastoma had his port accessed.  (He's had it for four months.)  Flushed and he had pain in his chest, about 4 inches superior to his port.  Minimal pinkish return upon withdrawal attempt.  RN reaccessed it.  Same issue, however with no pink.  When they flushed (it flushed easily), they noted that the catheter could be seen more easily, kind of bulging.  I was called over to evaluate it.  Well, in my way of thinking, if this is the first time he is having pain with each flush (no pain at access point), must be something wrong with the port system.  Sent him to interventional radiology and, lo and behold, they saw a large catheter fragment in the right chambers of his heart.  It was removed with a snare and a new port placed in the IJ.  In follow-up with RNs, he is a weight lifter--it's his whole life.  I suspect all those bench presses and more contributed to some compression of the catheter between the clavicle and 1st rib.  Any other thoughts?

lynncrni
Was this catheter inserted
Was this catheter inserted via the subclavian vein or the internal jugular? If subclavian, then pinch-off syndrome leading to catheter fracture and embolization would be my first guess as to the cause. Use of his upper body contributed to the catheter fracture but the site of venipuncture was the actual cause. If the subclavian region is the preferred site, then the actual venipuncture should be more lateral into the axillary vein. It is for this reason that most radiologists choose the IJ for insertion with the port pocket still on the upper chest. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

dfritz
Subclavian--inserted by a
Subclavian--inserted by a surgeon.
lynncrni
Then I would definitely say
Then I would definitely say this was pinch-off syndrome that lead to a complete catheter fracture and embolization. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

pinch off?  Did they have trouble with blood return on the port unless he raised his arm?

Kathy Kokotis

Bard Access Systems

dfritz
He was in a recliner in the
He was in a recliner in the Inf Ctr whenever he was accessed.  No, no issues that I'm aware of with blood return.  But I think his leisure activity of pumping iron may have caused a pinch off syndrome during his weight lifting repititions.
Cindy Kahnk
I am looking for

I am looking for evidence-based journal articles that support verifying port function with a blood return.  And if no blood return, then a dye study is needed.

 

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