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Delayed pneumothorax after central venous access: a potential hazard

J G Tyburski1, A L Joseph, G A Thomas

  • 1Department of Surgery, Wayne State University, Detroit, Michigan.

The American Surgeon
|September 1, 1993
PubMed
Summary
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Delayed pneumothorax after central venous catheter placement is a rare but serious complication. Immediate chest X-rays may appear normal, necessitating a high index of suspicion for timely diagnosis and treatment, especially in ventilated patients.

Area of Science:

  • Medical Procedures
  • Pulmonary Medicine
  • Patient Safety

Background:

  • Percutaneous central venous catheterization is a frequent procedure in surgical patients.
  • Pneumothorax is the most common major complication associated with central venous catheter placement.
  • Routine assessment involves chest X-ray within 2 hours post-insertion.

Purpose of the Study:

  • To report on cases of delayed pneumothorax following central venous catheterization.
  • To review the literature on this specific complication.
  • To emphasize the importance of recognizing and managing delayed pneumothorax.

Main Methods:

  • Retrospective identification of five patients with delayed pneumothorax.
  • Review of English literature for similar cases.

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  • Analysis of clinical presentation and outcomes.

    • Main Results:

    • Five cases of delayed pneumothorax were identified over a 6-month period.
    • All initial post-insertion chest X-rays were normal.
    • Delayed pneumothorax was life-threatening in one patient on positive pressure ventilation.
    • A total of 18 cases were found in the literature.

    Conclusions:

    • Delayed pneumothorax, though rare, is a potentially fatal complication of central venous access.
    • A high index of suspicion is crucial for diagnosis, particularly in patients on positive pressure ventilation.
    • Prompt diagnosis and treatment are essential for managing this reversible condition.