PINCH-OFF SYNDROME - A RARE ETIOLOGY FOR CENTRAL VENOUS CATHETER OCCLUSION

Background: Catheter pinch-off syndrome is a rare and often misdiagnos ed complication of tunneled Silastic central venous catheters. Pinch-o ff syndrome occurs when the catheter is compressed between the first r ib and the clavicle, causing an intermittent mechanical occlusion for both infusion and withdrawal. We report its incidence in a large serie s of catheter insertions and describe the clinical presentation, radio graphic findings, and recommended treatment. Methods: A total of 1457 tunneled Silastic central venous catheters that were inserted using th e percutaneous subclavian approach were prospectively studied. Indicat ions for catheter placement included bone marrow transplant, continuou s or intermittent chemotherapy, long-term antibiotics, and parenteral nutrition. Catheters were evaluated for clinical presentation of an oc clusion relieved by postural changes and radiographic findings of lumi nal narrowing. Results: Pinch-off syndrome was identified in 16 (1.1%) catheters. Radiographic findings were present in all catheters; clini cal findings were present in 15 catheters, Clinical symptoms presented within a median of 2 days after placement (range, 0 to 167 days). Par tial or complete catheter transection, a serious sequela of catheter p inch-off syndrome, occurred in 19% of the identified catheters. Conclu sions: (1) Catheter pinch-off syndrome presents clinically as a cathet er occlusion related to postural changes; (2) clinical symptomatology should be confirmed radiographically; and (3) catheter removal with a more lateral replacement in the subclavian vein or in the internal jug ular vein will avoid a recurrent complication.