Franey T, DeMarco LC, Deiss AC, Ward RJ. Catheter fracture and embolization in a totally implanted venous access catheter. J Parenteral and Enteral Nutr 1988;12:528-530.

A totally implanted venous access system was placed in a 24-year-old male patient with Hodgkins disease for chemotherapy. Twelve months after implantation it was noted on chest x-ray that the catheter had fractured and the distal fragment embolized to the right ventricle. Catheter separation and embolization is a recognized but uncommon complication of Hickman catheters. It is an even rarer complication of implanted central venous catheters. With the increasing use of these new venous access systems this complication may become a more prevalent, but an avoidable complication. …Catheter fracture is a relatively rare complication but it can be avoided. By entering the subclavian vein lateral to the midclavicular point the catheter passes through the widest portion between the clavicle and first rib which is in the subclavian vein. It is also important to remember when handling the catheter prior to insertion to avoid traumatizing it. Small cracks or nicks in the Silastic may weaken the material predisposing it to leaks or fracture. If there is difficulty in cannulating the subclavian vein lateral to the midcalvicular point the catheter can be inserted using several other alternatives sites. Alternative site include the cephalic vein, internal; jugular veins. …An upright chest x-ray should be performed after insertion of the catheter checking for pneumothorax, pleural effusion, catheter position, catheter integrity and particular attention for a pinch-off sign. If a pinch-off sign is detected the catheter should be removed and reinserted either laterally, or through an alternate site.

Abstracted with permission from the American Society for Parenteral and Enteral Nutition, © 1988.