[Complications and management of percutaneous central venous access catheter]

The recently developed method of percutaneous subclavian implantation of an indwelling central venous catheter provides convenient access for patients requiring long-term intravenous therapy. To evaluate, clinical complications and its management, we reviewed 145 implanted central venous systems in 135 patients during a 7 month period. The implantation failed in two patients due to difficult subclavian punctures. The major complications were pinch-off sign observed in 5 patients, inflammation in 6 patients (4.2%), and subclavian vein thrombosis in 7 patients, and other miscellaneous complications in 7 patients. It was revealed the pressure between the clavicle and first rib attributed to "pinch-off sign", which could be avoided by a lateral subclavian vein approach. Meticulous disinfection before use of the system is advised since most infections was derived from the injection site. We also suggest the the catheter should be placed at the lower part of the superior vena cava because the development of thrombosis is highly poelated. Seven patients required removal of the system, however, all patients with complications had good Port A function adequate management or revision operation. Percutaneous subclavian implantation of indwelling central venous catheter is safe and reliable.