SPONTANEOUS LEAK AND TRANSECTION OF PERMANENT SUBCLAVIAN CATHETERS

Background and Objectives: Implanted central venous access pol:ts are frequently used. Spontaneous break and catheter transection are seriou s but rare complications of permanent subclavian catheters. We report our experience with this serious complication and identify possible wa rning signs. Materials and Methods: Between 1990 and 1996, 285 permane nt subclavian catheters were placed at the Sheba Medical Center, Tel H ashomer, Israel. Results: We evaluated the patient population for this complication and searched for possible warning signs. A total of 12 p atients (4.2%) with this complication were identified, 8 with transect ion and distal embolization and 4 with a partial tear only. The pinch- off sign was noted as an early warning in only 5 patients. All other p atients developed symptoms only immediately before the diagnosis of th is complication. The mean duration from insertion to identification of tear or transection was 9.6 months (range 1-24 months). Conclusion: A wareness and clinical suspicion are most important in identification a nd prevention of this serious complication. Catheters should be taken out when treatment is completed or after 12 months in order to prevent catheter breaks. (C) 1998 Wiley-Liss, Inc.