Friday, 2 March 2018

Complications of subclavian Vein Catheterization and Their Management in the ICU


The subclavian approach remains the most commonly used blind approach for subclavian vein catheterization (SVC). Its advantages include consistent landmarks, increased patient comfort, and lower potential for infection or arterial injury compared with other sites of access. However, the list associated with this procedure is quite long. Thus, we describe here the case of three patients in whom serious but preventable SVC complications occurred in an intensive care unit (ICU). We emphasize the role of proper management for minimizing the negative consequences associated with SVC.

Subclavian vein catheterization (SVC) is a technique used worldwide millions of times each year for the management of perioperative fluids or the administration of chemotherapy, total parenteral nutrition, or long-term antibiotics. This procedure is often a successful and uncomplicated. However, reported complication rates range from 0.3 to 12 %, according to the experience of the physician and the definition of complications. Potential complications include failure to locate or cannulate the vein, puncture of the subclavian artery, misplacement of the catheter (placement of the catheter tip in the contralateral subclavian vein or in either jugular vein), pneumothorax, mediastinal hematoma, haemothorax, and injury to adjacent nerves. Except for the physician’s experience, the risk factors for complications and failures of subclavian-vein catheterization are poorly understood. Here, we present our gained experience from more than one hundred SVCs performed in one month in our 14-bed ICU, reporting the case of complications that occurred during the attempts to cannulate the subclavian vein of three patients who were admitted to our intensive care unit (ICU) and we discuss the management of such complications. 

A 52-year-old overweight patient was admitted in the ICU with acute respiratory failure, exacerbated by his chronic obstructive pulmonary disease. He was placed under mechanical ventilation and on the sixth day of his hospitalization a subclavian catheter was placed on the right side to measure central venous pressure. Chest X-rays after cannulation showed right pneumothorax and subcutaneous emphysema. The catheter was removed, and thoracentesis was performed. The patient continuously improved his condition and was released from the ICU on the 15th day of his hospitalization. 

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