[Injuries to blood vessels near the heart caused by central venous catheters]

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Critical Care Medicine

Background:

• Central venous catheterization is a common procedure with potential risks including vascular injury.
• Subclavian vein access, while having lower risks of sepsis and thrombosis than other sites, carries significant risks of pneumothorax and hemothorax.
• Arterial injuries during central venous puncture can lead to severe hemorrhage and shock.

Observation:

• This report details 6 patients experiencing life-threatening complications from subclavian artery and vein injuries during central venous access.
• Complications from central venous catheters are diverse and not always immediately apparent.
• Damage to the subclavian vessels can occur during both intended and accidental punctures.

Findings:

• Injury to the subclavian artery and vein during central venous puncture can result in critical, life-threatening complications.
• The subclavian approach has specific risks, including pneumothorax and hemothorax, distinct from other central venous access sites.
• Alternative approaches, such as axillary vein puncture, may offer improved ultrasound visualization and a safer distance from the lungs.

Implications:

• Careful selection of the central venous access route, considering patient factors and clinical context, is crucial for minimizing complications.
• The axillary vein puncture is presented as a potentially safer alternative for central venous catheterization, offering better imaging and reduced risk of thoracic injury.
• Awareness of potential vascular injuries and their severe consequences underscores the need for meticulous technique and appropriate site selection in central venous access procedures.