Pinch off syndrome
Updates to Article Attributes
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was changed:
Pinch-off syndrome is a spontaneous catheter fracture which is seen as a complication of subclavian venous catheterisation.
Incidence
It is a known complication of central venous catherisation with a much reduced incidence in current practice and is generally considered to be rare.
Indications for catheterisation
- chemotherapy via a port
- central venous pressure monitoring
- hemodialysis
Radiographic evaluation
An upright chest x-ray is mandatory post insertion.
CXR:Chest radiograph
look for catheter deviation, luminal narrowing and discontinuity (fracture) of the tube
Grades of abnormality1
Grade
-
grade 0: no narrowing in the catheter's course
Grade -
grade 1: deviation of the catheter with no luminal narrowing
Grade -
grade 2: luminal narrowing as the catheter passes under the clavicle (pinch-off sign)
Grade - grade 3: transection of the catheter between the clavicle and the 1st rib with embolization of the distal catheter
Complications
Reported complications include
-
hemothoraxhaemothorax - pneumothorax
- vascular perforation
- mediastinal
hematomahaematoma - myocardial injury due to embolisation of the distal catheter into the right atrium
Treatment
Once detected on the chest x-ray immediate removal is advised.
History and etymology
FirstIt was first described by Hinke et al in 1990.
-</ul><h4>Radiographic evaluation</h4><p>An upright chest x-ray is mandatory post insertion.</p><h5>CXR:</h5><p>look for catheter deviation, luminal narrowing and discontinuity (fracture) of the tube</p><h6>Grades of abnormality<sup>1</sup>-</h6><p>Grade 0: no narrowing in the catheter's course</p><p>Grade 1: deviation of the catheter with no luminal narrowing</p><p>Grade 2: luminal narrowing as the catheter passes under the clavicle (pinch-off sign)</p><p>Grade 3: transection of the catheter between the clavicle and the 1st rib with embolization of the distal catheter</p><h4>Complications</h4><ul>-<li>hemothorax</li>-<li>pneumothorax</li>- +</ul><h4>Radiographic evaluation</h4><p>An upright chest x-ray is mandatory post insertion.</p><h5>Chest radiograph</h5><p>look for catheter deviation, luminal narrowing and discontinuity (fracture) of the tube</p><h6>Grades of abnormality<sup>1</sup>
- +</h6><ul>
- +<li>
- +<strong>grade 0</strong>: no narrowing in the catheter's course</li>
- +<li>
- +<strong>grade 1</strong>: deviation of the catheter with no luminal narrowing</li>
- +<li>
- +<strong>grade 2</strong>: luminal narrowing as the catheter passes under the clavicle (pinch-off sign)</li>
- +<li>
- +<strong>grade 3</strong>: transection of the catheter between the clavicle and the 1st rib with embolization of the distal catheter</li>
- +</ul><h4>Complications</h4><p>Reported complications include</p><ul>
- +<li><a title="Haemothorax" href="/articles/haemothorax">haemothorax</a></li>
- +<li><a title="Pneumothorax" href="/articles/pneumothorax">pneumothorax</a></li>
-<li>mediastinal hematoma</li>- +<li>mediastinal haematoma</li>
-</ul><h4>Treatment</h4><p>Once detected on the chest x-ray immediate removal is advised.</p><h4>History and etymology</h4><p>First described by <strong>Hinke et al</strong> in 1990.</p><p> </p><p> </p>- +</ul><h4>Treatment</h4><p>Once detected on the chest x-ray immediate removal is advised.</p><h4>History and etymology</h4><p>It was first described by <strong>Hinke et al</strong> in 1990.</p><p> </p><p> </p>
References changed:
- 2. Mirza B, Vanek VW, Kupensky DT. Pinch-off syndrome: case report and collective review of the literature. Am Surg. 2004;70 (7): 635-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15279190">Pubmed citation</a><span class="auto"></span>
- 2.Mirza B, Vanek VW, Kupensky DT. Pinch-off syndrome: case report and collective review of the literature. Am Surg. 2004;70 (7): 635-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15279190">Pubmed citation</a><span class="auto"></span>
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