Subclavian vein injury during placement of the right internal jugular dialysis catheter

Abstract

We present a case of a serious complication during placement of a tunneled central venous line due to rupture of the right subclavian vein and subsequent right hemothorax and hemomediastinum that warranted surgical intervention. The surgery was successful, however, the patient died of multiple comorbidities and multiorgan failure 4 days later.

A Rare Complication of Internal Jugular Vein Cannulation Following Subcutaneous Implanted Port Placement

“…Of the various complications that may arise during internal jugular vein cannulation, acute complications include venous rupture as well as arterial punctures, which occur at an incidence of <1%. These acute complications are significant as they can lead to potentially fatal hemothorax formation [ 2 ]. Subclavian catheterization is more likely than internal jugular catheterization to be complicated by pneumothorax and hemothorax formation [ 6 ].…”

“…Contributing risk factors for hemothorax formation in our case could also be attributed to morbid obesity and a short neck length. These known risk factors for hemothorax formation may be attributed to the possible kinking of the dilators, catheters, and sheaths [ 2 ].…”

“…Complications following port placement surgery can be of various etiologies and can be divided into early and delayed complications based on the time of onset. Early complications include venous malpositioning, pneumothorax, hemothorax, thoracic duct injury, or even cardiac tamponade [ 2 - 4 ]. Delayed complications include infection, catheter thrombosis, vessel thrombosis and stenosis, catheter fracture with extravasation, or fracture with migration or embolization of catheter material [ 5 ].…”