Pinch off syndrome
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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.
Chest radiograph
look for catheter deviation, luminal narrowing and discontinuity (fracture) of the tube
Grades of abnormality1
- grade 0: no narrowing in the catheter's course
- grade 1: deviation of the catheter with no luminal narrowing
- grade 2: luminal narrowing as the catheter passes under the clavicle (pinch-off sign)
- grade 3: transection of the catheter between the clavicle and the 1st rib with embolization of the distal catheter
Complications
Reported complications include
- haemothorax
- pneumothorax
- vascular perforation
- mediastinal haematoma
- 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
It was first described by Hinke et al in 1990.
-<li><a title="Haemothorax" href="/articles/haemothorax">haemothorax</a></li>-<li><a title="Pneumothorax" href="/articles/pneumothorax">pneumothorax</a></li>- +<li><a href="/articles/haemothorax">haemothorax</a></li>
- +<li><a href="/articles/pneumothorax">pneumothorax</a></li>
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