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to the break, cleaned with alcohol and covered with sterile dressing until repaired.
Optimally, a person familiar with the procedure will be available within a short
time of clamping the catheter or folding the catheter on itself, or, if feasible, tying
the broken end into a knot. If the externalized portion is too small to clamp,
hemostasis may be achieved by putting pressure on the site of venous entry. A
scar is usually apparent at this site. However, if the scar is not apparent, the
catheter should be palpated from the exit site on the skin to the location at which
it can no longer be palpated and pressure should be applied at that site. Repair kits
are available for each catheter size ( Fig. 135.9 ). These kits contain a new
external catheter segment with a hollow male connector that fits into a cleanly
sliced proximal end. The kits also contain a syringe and needle to apply the glue
to the male connector.
If an implantable catheter leaks, fluid or blood that collects subcutaneously
may cause a bulge or painful swelling at the site. A broken implanted catheter
must undergo prompt surgical management. The broken segment can often be
easily visualized by chest radiography.
Catheter Displacement
Occasionally, the patient or caregiver inadvertently pulls on the externalized
portion of a tunneled catheter, and can be noted by visualization of the cuff at or
outside of the exit site. The venous portion of the catheter may eventually be
displaced from the venous system. Externalized catheters are at higher risk for
dislodgment within a few weeks of insertion, because the cuff is not fully
anchored by fibrosis. Exsanguination after catheter dislodgment is a rare event
because of the advancement of the tip inside the vein and the natural tendency
toward venous hemostasis. However, children with clotting disorders are at
increased risk of life-threatening blood loss after catheter displacement. Totally
implanted devices are at risk of dislodgment at both ends; however, few events
apart from major thoracic trauma place enough tension on the catheter to dislodge
it from the vein. Migration of the venous catheter tip is rare but can lead to
cardiac arrhythmias, pneumothorax, cardiac tamponade, and superior vena cava
syndrome.