Pinch-off syndrome is a spontaneous catheter fracture, which is seen as a complication of subclavian venous catheterisation.
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Epidemiology
It is a known complication of central venous catheterisation with a much-reduced incidence in current practice and is generally considered to be rare.
Radiographic features
Plain radiograph
An upright chest x-ray is mandatory post insertion. Look for catheter deviation, luminal narrowing and discontinuity (fracture) of the tube.
Grades of abnormality
- 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 embolisation of the distal catheter 1
Complications
Reported complications include:
- haemothorax
- pneumothorax
- vascular perforation
- mediastinal haematoma
- myocardial injury due to embolisation of the distal catheter into the right atrium
Treatment and prognosis
Once detected on the chest x-ray immediate removal is advised.
History and etymology
Hinke et al. first described it in 1990.
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