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Lolly · 08-14-2006, 07:33 AM

Steph, I can completely symphathize with your ordeal as I am on my third port since 2001. My problems were caused by "pinch-off" syndrome, and I've copied a PubMed article and included the link so others can be aware of this rare complication. The symptoms are very similar to those caused by a fibrin sheath, but my ports would also be difficult to infuse, a give-away for this complication. My surgeon finally got around this problem by by-passing the clavicular junction and accessing the vein in my shoulder.
Even though I've had a few problems with my port(s), I would not consider doing without it as I only have one good vein in my one good arm (lymphedema in the other).

Pinch-Off Syndrome/PubMed
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

Pinch-off syndrome: a rare etiology for central venous catheter occlusion.

Andris DA, Krzywda EA, Schulte W, Ausman R, Quebbeman EJ.

MedicalCollege of Wisconsin, Department of Surgery, Milwaukee53226, USA.

BACKGROUND: Catheter pinch-off syndrome is a rare and often misdiagnosed complication of tunneled Silastic central venous catheters. Pinch-off syndrome occurs when the catheter is compressed between the first rib and the clavicle, causing an intermittent mechanical occlusion for both infusion and withdrawal. We report its incidence in a large series of catheter insertions and describe the clinical presentation, radiographic findings, and recommended treatment. METHODS: A total of 1457 tunneled Silastic central venous catheters that were inserted using the percutaneous subclavian approach were prospectively studied. Indications for catheter placement included bone marrow transplant, continuous or intermittent chemotherapy, long-term antibiotics, and parenteral nutrition. Catheters were evaluated for clinical presentation of an occlusion relieved by postural changes and radiographic findings of luminal narrowing. RESULTS: Pinch-off syndrome was identified in 16 (1.1%) catheters. Radiographic findings were present in all catheters; clinical findings were present in 15 catheters. Clinical symptoms presented within a median of 2 days after placement (range, 0 to 167 days). Partial or complete catheter transection, a serious sequela of catheter pinch-off syndrome, occurred in 19% of the identified catheters. CONCLUSIONS: (1) Catheter pinch-off syndrome presents clinically as a catheter 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 jugular vein will avoid a recurrent complication.

08-14-2006, 07:33 AM	#4
Lolly Senior Member Join Date: Aug 2001 Location: Oregon Posts: 1,756	"Pinch-Off" Syndrome Steph, I can completely symphathize with your ordeal as I am on my third port since 2001. My problems were caused by "pinch-off" syndrome, and I've copied a PubMed article and included the link so others can be aware of this rare complication. The symptoms are very similar to those caused by a fibrin sheath, but my ports would also be difficult to infuse, a give-away for this complication. My surgeon finally got around this problem by by-passing the clavicular junction and accessing the vein in my shoulder. Even though I've had a few problems with my port(s), I would not consider doing without it as I only have one good vein in my one good arm (lymphedema in the other). Pinch-Off Syndrome/PubMed http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract Pinch-off syndrome: a rare etiology for central venous catheter occlusion. Andris DA, Krzywda EA, Schulte W, Ausman R, Quebbeman EJ. MedicalCollege of Wisconsin, Department of Surgery, Milwaukee53226, USA. BACKGROUND: Catheter pinch-off syndrome is a rare and often misdiagnosed complication of tunneled Silastic central venous catheters. Pinch-off syndrome occurs when the catheter is compressed between the first rib and the clavicle, causing an intermittent mechanical occlusion for both infusion and withdrawal. We report its incidence in a large series of catheter insertions and describe the clinical presentation, radiographic findings, and recommended treatment. METHODS: A total of 1457 tunneled Silastic central venous catheters that were inserted using the percutaneous subclavian approach were prospectively studied. Indications for catheter placement included bone marrow transplant, continuous or intermittent chemotherapy, long-term antibiotics, and parenteral nutrition. Catheters were evaluated for clinical presentation of an occlusion relieved by postural changes and radiographic findings of luminal narrowing. RESULTS: Pinch-off syndrome was identified in 16 (1.1%) catheters. Radiographic findings were present in all catheters; clinical findings were present in 15 catheters. Clinical symptoms presented within a median of 2 days after placement (range, 0 to 167 days). Partial or complete catheter transection, a serious sequela of catheter pinch-off syndrome, occurred in 19% of the identified catheters. CONCLUSIONS: (1) Catheter pinch-off syndrome presents clinically as a catheter 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 jugular vein will avoid a recurrent complication. Last edited by Lolly; 08-14-2006 at 07:39 AM..