Pediatr Radiol DOI 10.1007/s00247-014-3254-z

LETTER TO THE EDITOR

Hickman line fracture in a road traffic accident Rachel M. Martin & Anne Paterson & Emma M. Crone & Anthony J. McCarthy

Received: 4 November 2014 / Accepted: 25 November 2014 # Springer-Verlag Berlin Heidelberg 2015

Sir, A 5-year-old oncology patient presented with a 24-h history of pain occurring whilst his Hickman line was being flushed. A linogram study was performed to check catheter integrity. It demonstrated a fracture involving both lumens of the right subclavian line (Fig. 1). A more detailed history was sought from the

patient’s mother, who revealed they had been involved in a traffic accident the previous day, ironically, as they traveled in the back of an ambulance. The patient had been wearing a seat belt at the time and the shoulder strap had been over his right shoulder; the deceleration force of the accident had been translated directly to the catheter tubing.

Fig. 1 Contrast injection via (a) left lumen and (b) right lumen of indwelling subclavian central venous catheter. There is leakage of contrast as the line crosses the outer aspect of the clavicle, exactly

where the shoulder strap of a seat belt runs (the external portion of the catheter tubing lies coiled on the anterior chest wall)

R. M. Martin : A. Paterson (*) : E. M. Crone Department of Paediatric Radiology, Royal Belfast Hospital for Sick Children, 180 Falls Road, Belfast BT12 6BE, UK e-mail: [email protected] A. J. McCarthy Department of Paediatric Oncology/Haematology, Royal Belfast Hospital for Sick Children, 180 Falls Road, Belfast BT12 6BE, UK

Pediatr Radiol

A review of the literature revealed only one previously reported case of central venous line fracture secondary to the shoulder strap of a seat belt – this in a 7-year-old girl with cystic fibrosis [1]. Parents of children with indwelling subclavian venous catheters are given extensive instructions on how to care for these lines at home. In our institution, they are now additionally advised to position their child’s car seat so that the shoulder belt is placed on the opposite side of the line to protect it in the event of an emergency stop.

Consent to submit this work and the accompanying images was obtained from the patient’s mother. Conflicts of interest None

Reference 1. Ghayyda SN, Roland D, Cade A (2008) Seat belt associated central line fracture – a previously unreported complication in cystic fibrosis. J Cyst Fibros 7:448–449

Hickman line fracture in a road traffic accident.

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