Fracture and migration of implantable venous access port catheters: Cause analysis and management of 4 cases

Abstract

This study aimed to investigate the causes and managements of the fractures and migrations of the implantable venous access port catheter (IVAPC). The fracture or migration of IVAPC occurred in 4 patients who were treated between May 2012 and January 2014 in Union Hospital, Wuhan, China. The port catheter leakage was found in 2 cases during drug infusion. Catheters that dislodged to the superior vena cava and right atrium were confirmed by port angiogram. The two dislodged catheters were successfully retrieved by interventional procedures. Catheter fracture occurred in two cases during port removal. One catheter was eventually removed from the subclavian vein through right clavicle osteotomy and subclavian venotomy, and the other removed by external jugular venotomy. Flushing the port in high pressure and injury of the totally implantable venous access port (TIVP) during implantation are usually responsible for catheter displacement. Interventional retrieval procedure can be used if the catheter dislodges to the vena cava and right atrium. Catheter fracture may occur during removal if clipping syndrome occurs or the catheter is sutured very tight during implantation.

Keywords

implantable venous access port / catheter migration / intervention / nurse care

References

[1] CherneckyC. Satisfaction versus dissatisfaction with venous access devices in outpatient oncology: a pilot study. Oncol Nurs Forum, 2001, 2(8): 1613-1616

[2] KurulS, SaipP, AydinT. Totally implantable venus-access ports: local problems and extravasation injury. Lancet Oncol, 2002, 3(11): 684-692 PMID: 12424071

[3] BabuR, SpicerRD. Implanted vascular access devices (ports) in children, complications and their prevention. Pediatr Surg Int, 2002, 18(1): 50-53 PMID: 11793064

[4] MaiseyNR, SacksN, JohnstonSR. Catheter fracture: a rare complication of totally implantable venous devices. Breast, 2003, 12(4): 287-289 PMID: 14659316

[5] ChoJB, ParkIY, SungKY, et al. . Pinch-off syndrome. J Korean Surg Soc, 2013, 85(3): 139-144 PMCID: 3764366 PMID: 24020024

[6] NagasawaY, ShimizuT, SonodaH, et al. . Is catheter rupture rare after totally implantable access port implantation via the right internal jugular vein? Report of a case. Surg Today, 2014, 44(7): 1346-1349 PMID: 23732842

[7] KaoCL, ChangJP. Catheter fracture and embolization from an implanted venous access device. J Emerg Med, 2002, 22(1): 95-96 PMID: 11809564

[8] LinCH, WuHS, ChanDC, et al. . The mechanisms of failure of totally implantable central venous access system: analysis of 73 cases with fracture of catheter. Eur J Surg Oncol, 2010, 36(1): 100-103 PMID: 19709847

[9] WangQ, XiongB, ZhengC, et al. . Percutaneous retrieval of PICC fractures via the femoral vein in six cancer patients. J Vasc Access, 2015, 16(1): 47-51 PMID: 25198814

[10] ChengCC, TsaiTN, YangCC, et al. . Percutaneous retrieval of dislodged totally implantable central venous access system in 92 cases: experience in a single hospital. Eur J Radiol, 2009, 69(2): 346-350 PMID: 17976941

[11] LiuJC, TsengHS, ChenCY, et al. . Percutaneous retrieval of 20 centrally dislodged Port-A catheter fragments. Clin Imaging, 2004, 28(3): 223-229 PMID: 15158231

[12] KuYH, KuoPH, TsaiYF, et al. . Port-A-Cath implantation using percutaneous puncture without guidance. Ann Surg Oncol, 2009729-734

[13] OsawaH, HasegawaJ, YamakawaK, et al. . Ultrasound- guided infraclavicular axillary vein puncture is effective to avoid pinch-off syndrome: a long-term follow- up study. Surg Today, 2013, 43(7): 745-750 PMID: 22922950

[14] ShimizuT, MekataE, MurataS, et al. . A case of catheter fracture of a totally implantable access port introduced through the rightinternal jugular vein. J Surg Oncol, 2011, 103(5): 460-461 PMID: 21400532

[15] GowdaMR, GowdaRM, KhanIA, et al. . Positional ventricular tachycardia from fractured mediport catheter with right ventricular migration—a case report. Angiology, 2004, 55(5): 557-560 PMID: 15378119

[16] J Vasc Access, 2012, 13(3

[17] TalwarV, PavithranK, VaidAK, et al. . Spontaneous fracture and pulmonary embolization of a central venous catheter. J Vasc Access, 2003, 44): 158-159 PMID: 17639496

[18] ChowLM, FriedmanJN, MacarthurC, et al. . Peripherally inserted central catheter (PICC) fracture and embolization in the pediatric population. J Pediatr, 2003, 142(2): 141-144 PMID: 12584534