Authors: Antoinette Van Meter, M.D. et al
Anesthesiology 12 2016, Vol.125, 1220.
IMPLANTED vascular access devices enable patients to receive long-term therapy, including chemotherapy, parenteral nutrition, and blood transfusions. While portal cathethers (PACs) rarely fracture (incidence, 0.4 to 1.8%), the most common location of fractures is at the space between the clavicle and the first rib. The catheter can also dislodge from the hub of the port.1,2 The figure is a chest x-ray of a 2 yr old, whose PAC had been placed 7 months before. The figure shows that the PAC shadow is not continuous, which is suspicious of a break in the catheter. A catheter fragment from the PAC located in the subclavian vein has broken off, passed the right atrium, and lodged into the right ventricle. It has dislodged from the hub of the port. This could have been prevented by ensuring a secure connection between the port and the hub when the PAC was placed. There are also preassembled systems that can be utilized, although they can still break or dislodge and embolize.