In-situ breakage of an implantable venous access system.

A totally implantable system for venous access (Port-A-Cath, Pharmacia, Nu-tech) has now entered clinical use. This system consists of a silastic catheter secured to a stainless steel reservoir with a locking ring. The system has been shown to have several advantages when compared with earlier venous access systems. However, the advantages of total implantation have also disposed the system to new complications. Two cases are presented of patients who had this system placed and developed in-situ separation of the catheter from the reservoir. The catheter was removed surgically from the subcutaneous tissues in one patient and with a Dormain basket in the second because complete migration of the catheter into the central venous system had occurred. In neither patient could the precise cause for the separation be ascertained. However, it can be appreciated that if chemotherapeutic agents were infused in these patients the results would have been disastrous. It is recommended that if blood cannot be easily aspirated after gentle to and fro flushes with a 10 ml syringe, a chest radiograph be obtained prior to the infusion of any substance to check for continuity in the system. Any breaks in the system should be immediately repaired since migration of the catheter into the venous system can occur.