Nietypowe zmiany położenia końcówki cewnika portu naczyniowego – opis przypadku

*Paweł Ciszewski, Joanna Tyczka, Zofia Choršży, Krystyna Sawicz, Mariusz Skrzypczak, Jacek Nadolski

Summary
Background.Permanently implanted subcutaneous devices are commonly used for chemotherapy, parenteral nutrition, haemophilia and other situations when permanent vascular access is necessary. Migration of a catheter is not uncommon and its correction requires surgical intervention. We describe a case when the catheter of an implanted system migrated several times.
Case report. A subcutaneous port system was implanted via the right subclavian vein into a 74-year-old man, who required frequent medications due to COPD, coronary insufficiency and diabetes. The surgery was uneventful, but after two weeks the patient reported unpleasant feelings during injections. A chest X-ray revealed migration of the catheter from the superior vena cava to the jugular vein. Open correction was undertaken, the catheter was shortened, and the patient was discharged home. After one month, he was again admitted to the hospital due to exacerbation of COPD. A chest X-ray revealed that the catheter had migrated again, and was visible in the superior vena cava. The whole system was removed a few months later because of infection.
Conclusion. We conclude that the risk of migration of a central venous catheter is increased in patients with elevated central venous pressure. In such cases, insertion via the left subclavian vein may be safer.

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