Catheter fracture: A rare complication of totally implantable subclavian venous access devices

Catheter fracture represents a rare problem among non‐infectious complications following the insertion of totally implantable long‐term central venous access systems for the application of chemotherapeutic agents. A literature survey revealed a total incidence of catheter fractures of 0–2.1%. Imminent catheter fracture can be identified radiologically, using different degrees of catheter narrowing between the clavicle and the first rib, called pinch‐off sign. Two cases of catheter fracture are described and potential causes are discussed. Recommendations to avoid the pinch‐off sign with the subsequent risk of catheter fracture and migration include a more lateral and direct puncture of the subclavian vein. In case of catheter narrowing in the clavicular‐first rib angle, patients should be followed carefully by chest X‐rays every 4 weeks. Whenever possible, the system should be removed within 6 months following insertion. © 1996 Wiley‐Liss, Inc.