Nace C S, Ingle R J
Dan Rudy Cancer Center, Saint Thomas Hospital, Nashville, TN.
Oncol Nurs Forum. 1993 Sep;20(8):1227-36.
Although uncommon, "pinch-off syndrome" and catheter fracture are reported complications of central venous catheters (CVCs). Pinch-off syndrome is characterized by intermittent catheter malfunction in conjunction with radiologic evidence of catheter compression. Warning signs of pinch-off syndrome include difficulty with-drawing blood samples and resistance to infusion of IV fluids. CVC fracture is characterized by migration of the distal catheter fragment through the heart and, often, into the pulmonary artery; it may be accompanied by the sudden onset of chest pain, palpitations, and arrhythmias. Twenty-seven cases of CVC fracture were reviewed, including 22 cases reported in the literature as well as an analysis of 5 cases that occurred at the authors' institution. Among the 22 cases reported in the literature, the average length of time between catheter insertion and fracture was 6.7 months. In 82% of these cases, the fracture occurred at the clavicle/first rib junction, where mechanical friction against the catheter has been well established as the mechanism for most fractures. In 9 of these 22 cases, evidence of catheter compression was noted on chest x-ray prior to fracture. This paper discusses assessment criteria for pinch-off syndrome and catheter fracture, as well as nursing implications regarding the prevention and early detection of these potentially serious complications.
尽管并不常见，但“夹闭综合征”和导管断裂是已报道的中心静脉导管（CVC）并发症。夹闭综合征的特征是导管间歇性故障并伴有导管受压的影像学证据。夹闭综合征的警示信号包括采血困难和静脉输液输注阻力。CVC断裂的特征是导管远端碎片经心脏游走，且常常进入肺动脉；可能伴有胸痛、心悸和心律失常的突然发作。回顾了27例CVC断裂病例，包括文献报道的22例以及对作者所在机构发生的5例病例的分析。在文献报道的22例病例中，导管插入与断裂之间的平均时间为6.7个月。在这些病例中，82%的断裂发生在锁骨/第一肋骨交界处，在该部位，导管受到的机械摩擦已被充分确认为大多数断裂的机制。在这22例病例中的9例中，在断裂前的胸部X光片上发现了导管受压的证据。本文讨论了夹闭综合征和导管断裂的评估标准，以及关于预防和早期发现这些潜在严重并发症的护理要点。
