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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 16-December-2005, Vol 118 No 1227

A rare complication of port-a-cath use
Omprakash Damodaran, Girish Mallesara
A 29-year-old man with Ewing’s sarcoma of his right posterior chest wall was admitted to the Oncology Unit for his second course of chemotherapy. To facilitate chemotherapy administration, a dual lumen port-a-cath had been inserted into the right subclavian vein 3 weeks earlier, with the tip of the catheter placed in the superior vena cava.
The patient felt some pain under his right clavicle after the nurse flushed normal saline into the catheter, after not being able to draw blood from both lumens. A chest X-ray taken following this (Figures 1 and 2) revealed a fractured tip of the catheter in a branch of the left lower pulmonary artery. The retrieval of the fragment was performed successfully, using a snare catheter passed through the right femoral vein (Figure 3). The patient recovered with no complications and continued with his chemotherapy.
Figure 1. Chest X-ray (PA view) Arrow shows port-a-cath fragment
Figure 2. Chest X-ray (lateral view) Arrow shows port-a-cath fragment
Figure 3. Retrieval of port-a-cath fragment

Discussion

It’s been estimated that less than 1% of indwelling venous catheters fracture.1 Aetiology might be associated with the pinching effect of the catheter as it passes between the clavicle and the first rib.2 Fractures can be minimised by instructing the patient to abstain from heavy physical activities or movement of the shoulder.3 Once a fracture has occurred, the fragment should be located and removed as soon as possible to prevent life-threatening dysrhythmias and other complications.3
Author information: Omprakash Damodaran, Medical Student (5th year), University of Newcastle, Newcastle, Australia; Girish Mallesara, Oncology Registrar, Department of Oncology, Mater Misericordiae Hospital, Newcastle, Australia
Acknowledgement: We thank Dr Fiona Able (Clinical Oncologist, Mater Hospital, Newcastle) for her assistance.
Correspondence: Omprakash Damodaran, 1/1 Ivor St, Lidcombe, NSW 2141, Australia. Email: domprakash@hotmail.com
References:
  1. Rubenstein RB, Alberty RE, Michels LG, et al. Hickman catheter separation. J Parenter Enterol Nutr. 1985;9:754–7.
  2. Aitken DR, Minton JP. The "Pinch-off sign": a warning of impending problems with permanent subclavian catheters. Am J Surg. 1984;148:633–6.
  3. Chang CL, Chen HH, Lin SE. Catheter fracture and cardiac migration—an unusual fracture site of totally implantable venous devices: report of two cases. Chang Gung Med J. 2005;28:425–30.
     
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