Pinch-Off Syndrome – Nurse Clinicians in Action-01

Pinch-Off Syndrome (ie, the compression and misalignment of a Peripherally Inserted Central Catheter (PICC), into a “v” position) and how the Vascular Access clinician diagnosed and treated the problem is the focus of this Nurse Clinicians in Action.

Pinch-Off Syndrome

– Clinical Case

This case took place in a hospital and the patient happened to be the best friend of the clinician’s father, which added some interesting dynamics.  The Vascular Wellness clinician placed a Peripherally Inserted Central Catheter (PICC) in the patient’s upper left arm as the patient had surgery on his right arm and was contraindicated for a PICC placement on that side.  The clinician verified the placement of the PICC and departed.  Sometime over the next few weeks, the PICC line started functioning intermittently on blood return and became difficult to flush.  The Vascular Wellness clinician was called back and after assessing the patient and PICC line, was able to restore the patency of the PICC.  About 30 minutes later, the patient’s wife contacted the clinician stating that the line was no longer functioning, and she returned to the hospital to re-examine the situation.

Pinch-Off Syndrome

– Diagnosis and Treatment

The Vascular Wellness clinician ordered a chest X-ray (see image) to check on the current PICC line placement and positioning.  She reviewed a side-by-side comparison of the first chest x-ray that confirmed the PICC placement and the current chest x-ray.  She first verified and confirmed that the PICC line correctly ended in the Superior Vena Cava (SVC) but, she did not stop there.  Using her experience and training, she kept looking and saw that the PICC was in a “v” position and out of alignment, a diagnosis called Pinch-Off Syndrome.

She reported her findings to the patient’s nurse and managing physician.  Although the managing physician had never heard of Pinch-Off Syndrome, she did some research and discussed it with other physicians and all of them concluded that the Vascular Wellness clinician was correct.  At this point, incorporating the detailed recommendation from the Vascular Wellness clinician, the managing physician developed a new treatment plan that included the removal of the PICC and placement of an Internal Jugular (IJ) line. The clinician was able to relay this difficult information to her father’s friend, who was very nervous at this point, and she placed the new line with a successful outcome.  After the line was placed, the patient said, “I wouldn’t let anyone but you do this to me.”  As vascular access experts who focus on vascular access daily, Vascular Wellness clinicians often provide additional and valuable clinical input to supplement a patient treatment plan similar to this situation.

After the IJ was successfully placed, the Vascular Wellness clinician reflected on the situation.  She believes that because the patient was unable to use his right arm due to the surgery, he overcompensated with his left arm which contained the PICC. This overcompensation and activity caused the PICC to kink along the brachial cephalic vein leading to the SVC.

Vascular Access Experts

– Key Points

Pinch-Off Syndrome is a rare syndrome but not without significant potential consequences.  If the catheter gets completely pinched off, it could eventually break and dislodge in the body.  This floating emboli (i.e., an object being carried in the bloodstream) in the body can travel to the heart, the lung, or the brain causing either a heart attack, a pulmonary embolism, or a stroke. In short, Pinch-Off Syndrome can result in significant injury and death.

Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.