Delayed pneumothorax after central venous access: a potential hazard

Percutaneous central venous catheter access is common-place in surgical patients. Though several major complications of this procedure have been described, pneumothorax is the most common. Pneumothorax is routinely assessed by a chest X-ray within 2 hours after catheter placement. During a recent 6-month interval, the authors identified five patients with delayed onset and diagnosis of pneumothorax following percutaneous central venous access. All immediate post-insertion chest X-rays were normal; however, subsequent chest X-ray showed evidence of pneumothoraxes. The pneumothorax contributed to the death of one patient on positive pressure ventilation. A review of the literature revealed a total of 18 patients in the English literature with this complication. Although the incidence of delayed pneumothorax is low, it is, in some instances, life threatening, particularly in patients on positive pressure ventilation. A high index of suspicion is required to diagnosis and treat this reversible condition.