Seat belt associated central line fracture--a previously unreported complication in cystic fibrosis

Abstract

Totally implantable venous access devices (TIVAD) are used widely in the management of cystic fibrosis (CF) [Standards of Care: Standards for the clinical care of children and adults with cystic fibrosis in the UK. The Cystic Fibrosis Trust's Clinical Standards and Accreditation Group. Cystic Fibrosis Trust, London, UK, 2001]. They have been shown to be safe and advantageous in the long term administration of intravenous antibiotics [A-Rahman A, Spencer D. Totally implantable vascular access devices for cystic fibrosis. Cochrane Database Syst Rev 2003(3)]. However, TIVADs are not without short and long term complications including infections, thrombosis and mechanical failure [Munck A, Malbezin S, Bloch J. Follow up of 452 totally implantable vascular devices in cystic fibrosis patients. Eur Respir J 2004;23:430-4; Aitkin ML, Tonelli ML. Complications of indwelling catheters in cystic fibrosis: a 10-year review. Chest 2000;118:1598-602; Deerojanawong J, Sawyer SM, Fink AM, Stokes KB, Robertson CF. Totally implantable venous access devices in children with cystic fibrosis. Thorax 1998;53:285-89; Rodgers HC, Liddle K, Nixon SJ, Innes JA, Greening AP. Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions. Eur Respir J 1998;12:217-20; Yung B, Campbell IA, Elborn JS, Harvey JS, Shale DJ. Totally implantable venous access devices in adult patients with cystic fibrosis. Respir Med 1996;90:353-56; Kariyawasam HH, Pepper JR, Hodson ME, Geddes DM. Experience of totally implantable venous access devices (TIV Ads) in adults with cystic fibrosis over a 13-year period. Respir Med 2000;94:1161-5]. Patients should be counselled prior to TIVAD insertion regarding the risks and instructed on post-operative care of the device to minimise the risks. However it is not routine practice to advise on seating position within the car in relationship to the seatbelt placement over the anterior chest wall. Line failure due to direct pressure from a seatbelt worn to prevent injury in the sudden deceleration involved during a motor vehicle accident (MVA) has not been described previously in the CF literature We report the case of an 8 year old child who fractured her Vascuport(R) line secondary to seatbelt trauma following a road traffic accident (RTA). Children and adults with CF should be advised to sit in the car on the side that places the shoulder strap of the seatbelt on the opposite side to the TIVAD line.