Pinch-off syndrome is a spontaneous catheter fracture, which is seen as a complication of subclavian venous catheterization.
It is a known complication of central venous catheterization with a much-reduced incidence in current practice and is generally considered to be rare.
An upright chest x-ray is mandatory post insertion. Look for catheter deviation, luminal narrowing and discontinuity (fracture) of the tube.
Grades of abnormality
- grade 0: no narrowing in the catheter's course
- grade 1: deviation of the catheter with no luminal narrowing
- grade 2: luminal narrowing as the catheter passes under the clavicle (pinch-off sign)
- grade 3: transection of the catheter between the clavicle and the 1st rib with embolization of the distal catheter 1
Reported complications include:
- vascular perforation
- mediastinal hematoma
- myocardial injury due to embolization of the distal catheter into the right atrium
Treatment and prognosis
Once detected on the chest x-ray immediate removal is advised.
History and etymology
Hinke et al. first described it in 1990.
- 1. Cho JB, Park IY, Sung KY et-al. Pinch-off syndrome. J Korean Surg Soc. 2013;85 (3): 139-44. doi:10.4174/jkss.2013.85.3.139 - Free text at pubmed - Pubmed citation
- 2. Mirza B, Vanek VW, Kupensky DT. Pinch-off syndrome: case report and collective review of the literature. Am Surg. 2004;70 (7): 635-44. Pubmed citation
- 3. Li H, Jen S, Keshavamurthy JH, Bowers GH, Vo HA, Rotem E. Imaging evaluation of catheter integrity prevent potentially fatal complication of pinch-off syndrome: illustration of two cases. Quantitative imaging in medicine and surgery. 7 (3): 369-372. doi:10.21037/qims.2017.05.01 - Pubmed