Broken Catheters in Epidural and Venous use
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Medical Injury due to Broken Catheters
Catheters that are not properly manufactured, are mishandled during insertion or tunneling, are not replaced when needed, or are incorrectly clamped, may fracture. Also, equipment used in conjunction with catheters, such as high-pressure infusion/injection pumps, can generate intra-catheter pressure significant enough to cause weakening or fracture of the catheter. 1 Unfortunately, fracture is a documented complication in all types of long-term venous-access catheters – Hickman, Vygon Nutricath-S, Port-a-Cath, Broviac, Groshong. If a fracture occurs a catheter fragment can embolize, following the circulatory system to the pulmonary artery or the heart. If this happens, an operation would be required to remove the fragment.
A common method of fracture is referred to as the ‘Pinch-off Syndrome’ in which the catheter is broken due to compression between the clavicle and the first rib. The compression causes wear on the catheter and can result in fracture, especially in patients needing a long-term catheter for venous access. The longer the catheter is in use, the higher the risk of fragmentation. Long-term venous access is often a necessity to chronically ill patients – delivering necessary antibiotics, nutritional support, and chemotherapy for patient care. Therefore, the danger from compression is two-fold: 1) potential fragmentation and embolism and 2) inability to deliver crucial medications or nutrients. However, careful placement of a catheter or review and replacement of a worn catheter could avoid these potential broken catheters.
For example, a malpositioned catheter passes through a smaller region of the space between the clavicle and first rib than does a properly positioned catheter. A catheter located in this areolar tissue is more susceptible to compression and fracture because it is more likely pinched by patient arm movement. A broken catheter could result in an embolism requiring an otherwise unnecessary medical procedure to remove the fragment. Depending on the size of the fragment and the location in the body, this procedure could be relatively simple or require major surgery. The preferred methods of emboli removal are by percutaneous extraction or non-surgical transvenous methods, such as using a snare to grab the catheter fragment. However, if this method is unsuccessful or impossible a major operation such as a thoracotomy is necessary.
Complications could also result from broken catheters such as:: fragments could cause a thrombosis, perforation of blood vessels, or bacterial infection. And if corrective action is not taken in time, serious injury, heart attack, or death could result. However, if a doctor inserts the catheter properly and monitors the status and placement of the catheter while inserted, harm is less likely to occur.
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Proposal for venous catheter DVT Modifications
Venous catheters are employed in cases of patients requiring long-term intravenous treatment. While they offer substantial benefits, there are potentially fatal risks associated with their use. One of these risks involves the spontaneous fracture, Broken Catheter, and resulting embolization (vessel occlusion), which are apparently caused by mechanical deterioration in the body.
The tensile strength and elongation before failure of six commonly used epidural catheters was investigated.
Lawyer obtains award for injury due to Broken Catheter. Reuse of single use catheters Biomedical Safety Standards Editor. Catheter for single use allegedly reused: broken tip leads to $970,000 award. Biomed Safety Standards 1981;(July 15):77.
Reuse of catheters can lead to several adverse consequences, including broken catheters. Broken Catheters and other associated risks from Journal of Cardiology
Medical Risks of an oxytocin infusion with Epidural Anesthesia During Childbirth.
Reuse of Disposable Medical Devices (Winter.1999/2000, Vol.25, No.3) There were several articles in the L.A. Times raising concerns about the lack of standards and the potential danger of this practice. The articles discussed instances where the tips of cardiac catheters had broken off in the hearts of patients and adverse patient reactions to bacterial toxins resulting from devices that were not properly cleaned.
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