• B Ouaknine-Orlando, E Desruennes, M F Cosset, T De Baere, and A Roche.
• Département anesthésie-analgésie-réanimation, Institut Gustave-Roussy, Villejuif, France.
• Ann Fr Anesth Reanim. 1999 Nov 1;18(9):949-55.

ObjectiveTo assess the incidence of the pinch-off syndrome (POS) in catheter fracture and embolism.Study DesignRetrospective clinical study.PatientsThe medical files of 56 patients who had since 1989 an embolized fragment or entire catheter removed by an interventional radiologic procedure have been retrospectively analysed.MethodsA POS was considered the causative factor when a chest X-ray showed a rupture of the catheter at the site of the costoclavicular space.ResultsFrom 1989 to the end of 1996, 56 catheter embolisms by fracture or disconnection occurred in our institution. The rupture from a POS was the main cause of embolism (24 patients out of 56). The incidence was 8/1000 of implanted ports inserted via a subclavian access [95% confidence interval: 4/1000-13/1000]. Preliminary clinical or radiologic signs of pinching existed in 50% of POS: difficult insertion, radiologic compression aspect, arm or shoulder pain, infusion rate and/or reflow depending on arm position.ConclusionsPOS was the first cause of catheter embolism and should suggest the use of an alternative way for insertion instead of the subclavian access. When a catheter is inserted via a subclavian route, clinical and/or radiologic signs of POS require its removal.

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