LONG-TERM SILASTIC CATHETERS AND CHEST PAIN

There are multiple reports in the literature of vascular erosion in th e innominate vein or superior vena cava from the use of temporary cent ral venous catheters. Catheter malposition is likely to precede the de velopment of superior vena cava perforations, a catastrophic complicat ion of central venous catheters. Catheter malposition after initial ad equate placement is a very unusual long-term complication and delayed recognition of this complication may have disastrous consequences. Sho uld the catheter change position so the tip is angled toward the sidew all, the repetitive movement of the catheter tip that occurs with resp iratory excursion and the cardiac cycle may lead to endothelial injury and eventual erosion of the vein. These problems are thought to be al leviated in the patient receiving long-term intravenous therapy by usi ng a soft Silastic catheter, which may not cause as much damage to the endothelium of the vein. We report three patients with left-sided lon g-term indwelling Silastic catheters that had changed position over ti me who presented with chest pain upon infusion of their total parenter al nutrition solutions. In each case, chest x-ray revealed that the ti p of the catheter had migrated and was directed against the sidewall o f the superior vena cava. In each case, catheter removal and replaceme nt with a new catheter into the right side (subclavian and jugular sys tems) led to prompt relief of the patient's symptoms.