Life-threatening vascular complications after central venous catheter placement

Abstract

The purpose of this retrospective study was to report 11 cases of severe vascular complications after central venous catheter misplacement. For each patient, data collection included body mass index, the diagnosis at admission, the site of the procedure, the type of catheter, coagulation parameters, the imaging modalities performed and the applied treatment. Eight patients had a lesion of the subclavian artery. Brachiocephalic vein perforations were assessed in three more patients. All patients had a chest roentgenogram after the procedure, six a CT examination, and four an angiographic procedure. Seven patients had a body mass index above 30, and 5 patients had coagulation disorders prior to the procedure. Seven patients were conservatively managed, 2 patients died despite resuscitation, 1 patient was treated with a stent graft, and one by superselective embolization. Subclavian or jugular vein temporary catheter positioning is a practical approach. Identification of any iatrogenic perforation of the subclavian artery or central veins urges obtaining a chest roentgenogram and, when required, a chest CT, selective angiograms or venograms. Body mass index superior to 30, previous unsuccessful catheterization attempts, and coagulation factor depletion seemed to account for risk factors. Recognition of clinical and radiological complications is mandatory.

Misplacements of Central Venous Catheters: Internal Jugular Versus Subclavian Access in Critical Care Patients

“…Guth (16) has claimed that the radiological control is not needed for catheterizations if complication is not suspected, while Whicky at al (1), and Gladwin at al (17) have suggested routine control of chest radiography. Radioscopy may also be used for this purpose (16).…”

“…CVC is used for administration of drugs, blood and its products, for central venous pressure (CVP) monitorization, total parenteral nutrition, and dialysis in renal failure. Internal jugular or subclavian veins are frequently used for this purpose (1).…”

Severe vascular complications of central venous line placement

“…Jeganath et al [13] reported successful coil embolization of a ruptured superior thyroid artery. Wicky et al [14] reported a series of 11 vascular complications after CVLP. Of them, seven were managed conservatively, one with a stent graft and one by superselective embolization.…”

Videothoracoscopic-guided management of a central vein perforation during hemodialysis catheter placement

“…Among the risks, there is the possibility of iatrogenic perforation of the central vein with bleeding into the pleural cavity. [1][2][3] Under this circumstance, the treatment involves thoracotomy and correction of the injury 4 or the use of an endoprosthesis 5 to occlude the perforation site.…”