Delayed pneumothorax after subclavian vein catheterization

One hundred fourteen patients having 121 subclavian venipunctures were studied retrospectively. Eight pneumothoraces occurred (6.6%) and were most frequent after the insertion of large catheters, or when the subclavian area was distorted by previous venipuncture or radiation. Delayed pneumothorax occurred in five patients. This unusual diagnosis was made radiographically 8 to 96 hr postoperatively in response to the appearance of new pulmonary symptoms. Delayed pneumothorax required treatment with tube thoracostomy more frequently than immediate pneumothorax. This study establishes the approximate incidence of delayed pneumothorax for the first time. The relative frequency of this complication may challenge the cost effectiveness of pneumothorax diagnosis by chest films done within 1 or 2 hr of subclavian venipuncture. An alternative diagnostic protocol is considered.