Sir,
I read an article titled “Catheter pinch-off syndrome” by Gandhi et al. with great interest.[1] They report an unusual and noteworthy case with high-quality images. I would like to congratulate all the authors for their excellent effort to report such a case. However, I would like to add some pertinent and interesting information about pinch-off syndrome which will help us and the field in general to prevent such complication.
Catheter pinch-off syndrome should be suspected if catheter is intermittently obstructed during administration and withdrawal of fluids within 3 weeks of insertion[2] or in patients who report difficulty in infusing in sitting position or when ipsilateral arm is elevated or abducted.[3]
I agree with the authors that this complication can be avoided using jugular or cephalic vein approach. In my humble opinion, it could also be avoided by placing a catheter in the most lateral part of the subclavian vein because of anatomical reason. Most lateral insertion of the catheter into the subclavian vein, where the angle between the clavicle and the first rib is wider, minimizes catheter compression.[3] The use of ultrasound to guide the placement of central venous accesses also helps to avoid such complication.[4]
In case of suspicion, chest radiograph should be obtained which usually demonstrate narrowing of the lumen of the catheter when it passes between the clavicle and first rib.
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REFERENCES
- 1.Gandhi VG, Rali P, Shah P, Cheema T. Catheter pinch-off syndrome. Lung India. 2017;34:470–1. doi: 10.4103/lungindia.lungindia_14_17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Aufderheide TP. Peripheral arteriovascular disease. In: Marx JA, Hockberger RS, Walls RM, editors. Rosen's Emergency Medicine. 8th ed. Philadelphia: Elsevier Saunders; 2014. pp. 1138–56. [Google Scholar]
- 3.Mansour JC, Niederhuber JE. Establishing and maintaining vascular access. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, editors. Abeloff's Clinical Oncology. 5th ed. Philadelphia: Elsevier Saunders; 2014. pp. 381–92. [Google Scholar]
- 4.Fragou M, Gravvanis A, Dimitriou V, Papalois A, Kouraklis G, Karabinis A, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study. Crit Care Med. 2011;39:1607–12. doi: 10.1097/CCM.0b013e318218a1ae. [DOI] [PubMed] [Google Scholar]