A46-20 A Case Report of Port Catheter Migration From Its Original Position

Abstract Introduction Implantable venous catheters are devices used to provide long-term venous access for chemotherapy, parenteral nutrition, prolonged antibiotics, and hemodialysis. Despite their clinical benefits, they are prone to complications. Early complications may include hemothorax, pneumothorax, vascular injury, air embolism, and catheter malposition, while late complications include infection, thrombosis, and extravasation of cytotoxic drugs. Here, we report a case of catheter tip migration from the superior vena cava to the ipsilateral axillary vein. Case Presentation 30 year old male with a history of advanced AIDS, disseminated Kaposi sarcoma, and recurrent pleural effusion status post right-sided PleurX catheter and a chemo port placed two months prior. He presented with a three day history of dry cough, exertional dyspnea, and right pleurx malfunction. Xray revealed recurrent bilateral pleural effusions and port catheter tip migration to the right axillary vein. IMAGE 1 THEN IMAGE 2. The port was successfully repositioned by the IR team. The pleurx catheter was flushed, restoring its function, and a left chest tube improved his respiratory symptoms. IMAGE 3. Pleural fluid cytology revealed a new lymphoma, and he was started on chemotherapy as per oncology. Discussion Catheter tip migration is a rare but documented complication of implantable devices with an estimated incidence of about 0.9 to 1.8 %. It typically occurs within the first 5 - 9 months after implantation.The flexibility of the catheter could be a predisposing factor for migration.While there is no clear mechanism for catheter migration, reported cases have been linked to increased intrathoracic or intra-abdominal pressures due to coughing, sneezing, straining, lesions, or high infusion rates.Common migration pathways include the subclavian to ipsilateral jugular vein or axillary vein, where the catheter is displaced backwards and upwards.Clinical presentation may range from asymptomatic to symptoms such as neck or shoulder pain, infection, thrombosis, perforation, or even neurological sequelae from a misplaced infusion of irritant medications. Routine imaging to confirm a catheter tip is crucial, especially when devices are not used frequently. Timely recognition and repositioning are essential with high success rates. However, there is a risk of recurrent malposition, and should be monitored closely. Conclusion This case highlights the importance of maintaining a high index of suspicion for catheter malposition in patients with implantable ports, particularly in the setting of increased pressures, functional failure, or difficulty with medication administration. Routine radiographic monitoring, especially following periods of nonuse, is recommended to prevent complications and ensure safe, effective treatment delivery. This abstract is funded by: no