Analysis of Central Venous Catheter Lacerations between the Pectoralis Major and Minor Muscles

Abstract

Objective : The subclavian or axillary vein was punctured and a totally implantable central venous (CV) access port was placed with ultrasonic guidance ; however, a catheter laceration between the pectoralis major and minor muscles occurred, which may be partly due to the catheter going through the pectoralis minor muscle. Therefore, an investigation was conducted to clarify the clinical characteristics of lacerations between the muscles. Method : Of the 269 patients who underwent CV port placement (subclavian or axillary vein puncture) between 2013 and 2017, 199 patients who underwent computed tomography imaging after placement were investigated. Patient baseline characteristics, whether there was access through the pectoralis minor muscle or not, puncture site, and the vascular visualization method, among other factors, were investigated in patients with (n=4) and without (n=195) lacerations between the muscles. Results : Univariate analysis revealed that lacerations between the muscles were observed more frequently in patients with access through the pectoralis minor muscle (p=0.002) and those with thick subcutaneous fat at the puncture site (p=0.002). Discussion : The involvement of the pectoralis minor muscle and subcutaneous fat thickness in catheter lacerations between the pectoralis major and minor muscles was suggested. To avoid access through the pectoralis minor muscle, punctures on the central side of the junction of the cephalic and axillary veins are useful. Conclusion : Anatomical understanding is vital before performing a catheter puncture.