What is the incidence of central venous catheter (CVC) fractures during insertion?

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Last updated: February 19, 2025 • View editorial policy

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From the Guidelines

The incidence of central venous catheter (CVC) fractures during insertion is relatively low.

Causes and Prevention of CVC Fractures

To minimize the risk of catheter fracture, it is recommended to use a careful and controlled insertion technique, avoiding excessive force or torque on the catheter 1.

  • Catheter Material: Using a catheter with a reinforced material, such as a polyurethane or silicone-coated catheter, may help reduce the risk of fracture.
  • Insertion Guidelines: It is also important to follow proper insertion guidelines, including using a suitable needle size and avoiding insertion through a small or fragile vein.
  • Ultrasound Guidance: The use of ultrasound guidance during CVC placement can also help reduce the number of complications, including catheter fractures 1.

Management of CVC Fractures

If a catheter fracture does occur, it is essential to remove the catheter and any fractured fragments as soon as possible to prevent further complications, such as embolization of the fractured fragment into the pulmonary vascular bed 1.

Best Practices for CVC Placement

Best practices for CVC placement, including the use of ultrasound guidance and careful insertion techniques, can help minimize the risk of catheter fractures and other complications 1.

From the Research

Incidence of Central Venous Catheter (CVC) Fractures

  • The incidence of CVC fractures during insertion is reported to be around 0.1%-1% 2, 3.
  • A literature survey revealed a total incidence of catheter fractures of 0-2.1% 3.
  • Mechanical complications related to CVC insertion, including fractures, are reported to be around 1% 4.
  • A retrospective multicenter study found that mechanical complications, including catheter fractures, occurred in 1.1% of CVC insertions 5.
  • Another study found that the total rate of one or more complications, including mechanical complications such as catheter fractures, occurring per CVC was 5.9% 6.

Risk Factors for CVC Fractures

  • The use of the modified Seldinger technique (ie, wire through the catheter technique) may increase the risk of catheter fragmentation 2.
  • Catheter narrowing in the clavicular-first rib angle, also known as the pinch-off sign, may increase the risk of catheter fracture 3.
  • Preprocedural coagulopathy, number of needle passes, and arterial puncture may be associated with an increased risk of mechanical complications, including catheter fractures 5.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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