What are the potential complications of central venous access via the subclavian vein?

Updated: Jul 24, 2020
  • Author: E Jedd Roe, lll, MD, MBA, FACEP, FAAEM, MSF, CPE; Chief Editor: Vincent Lopez Rowe, MD  more...
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Multiple studies have shown lower rates of local or systemic infection with the use of maximal sterile-barrier precautions, including mask, cap, sterile gown, sterile gloves, and large sterile drape. This approach has been shown to reduce the rate of catheter-related bloodstream infections (CRBSIs) and to save an estimated $167 per catheter inserted. [6]

Lacerating or puncturing the subclavian artery is theoretically possible, but the risk of this complication is higher with other approaches. The subclavian artery cannot be compressed; accordingly, the subclavian approach should be avoided in anticoagulated patients.

A hematoma usually requires monitoring only.

Check the chest radiograph for evidence of a hemothorax. If evidence is found, consult a surgeon immediately. In addition, check the chest radiograph for evidence of pneumothorax when finished or before switching to the contralateral side after failed insertion on one side.

Catheter-related thrombosis may lead to pulmonary embolism.

An air embolism may be caused by negative intrathoracic pressure, with inspiration by the patient drawing air into an open line hub. Be sure the line hubs are always occluded. Placing the patient in the Trendelenburg position lowers the risk of this complication.

If air embolism does occur, the patient should be placed in Trendelenburg position with a left lateral decubitus tilt, which may prevent the movement of air into the right ventricle and onward into the left side of the heart. Administration of 100% oxygen should be initiated to speed the resorption of the air. If a catheter is located in the heart, aspiration of the air should be attempted.

Dysrhythmia may occur as a consequence of cardiac irritation by the wire or catheter tip. It can usually be terminated by simply withdrawing the line into the superior vena cava. Placing a central venous catheter without a cardiac monitor is unwise.

Atrial wall puncture can lead to pericardial tamponade.

If the clinician is not conscientious about maintaining control of the guide wire, it may be lost into the vein and consequently may have to be retrieved by interventional radiology.

Patients who are allergic to antibiotics may experience anaphylaxis upon insertion of an antibiotic-impregnated catheter.

Occasionally, the catheter tip may lie too deep. Check for this complication on the postprocedure chest radiograph, and pull the line back if the tip disappears into the cardiac silhouette.

When the subclavian catheter is not in the correct position, it most often deviates cranially up the internal jugular vein instead of down the subclavian vein. Flushing 10 mL of saline through the distal port and palpating the neck for a thrill can help to detect misplacement of a subclavian venous catheters into the ipsilateral internal jugular vein. [17]

Chylothorax is a possible complication on the left side.

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