Catheter fracture and cardiac migration--an unusual fracture site of totally implantable venous devices: report of two cases.

Totally implantable venous devices (TIVDs) are used increasingly in patients with cancers and other debilitating diseases requiring long-term chemotherapy, total parental nutrition, and fluid replacement. The TIVDs are surgically inserted and fixed in the soft tissues of the chest wall to prevent infection and accidental dislodgment. Acute and chronic complications associated with these catheters include infection, thrombosis, venous perforation, catheter leakage, dislodgment and fall out, subintimal entrapment, and tip migration to neighboring veins after satisfactory initial placement. Catheter fracture and cardiac migration is a rare complication and most reported cases have developed between the clavicle and the first rib as a consequence of a pinch-off sign. We present two patients with metastatic colon cancers with unusual catheter fracture site and migration and discuss the clinical implications.