Subclavian Venipuncture

Défalque, Ray J.

doi:10.1213/00000539-196811000-00007

Cited by 53 publications

(19 citation statements)

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“…Accidental puncture of the subclavian or innominate artery may occur in 2-3% of subclavian venepunctures, but it is said to be easily recognised and without sequelae (Defalque, 1968). Macaulay and Wright (1970) mentioned accidental subclavian artery puncture in one patient who was receiving anticoagulants without ill effect.…”

Section: Discussionmentioning

confidence: 99%

Haemothorax after subclavian vein cannulation.

Holt¹,

Kirkham²,

Myerscough³

1977

Thorax

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Ten minutes after the procedure the patient complained of pain in the left infrascapular region. A chest radiograph revealed patchy opacification in the left mid and lower zones of the lung fields ( Fig. 1) but clinical examination of the chest was normal. She maintained satisfactory progress until seven hours after the procedure when she collapsed with tachypnoea, tachycardia, hypotension, and signs of a large left pleural effusion. A chest radiograph confirmed a pleural effusion on the side of the cannulation (Fig. 2). Intrathoracic bleeding was diagnosed and after rapid blood transfusion emergency thoracotomy was performed.At operation 4 litres of blood were evacuated from the left hemithorax. A puncture site was noted in the left subclavian vein, and at the corresponding position on the apex of the left lung a branch of the pulmonary artery was bleeding profusely. A few fibrous pleural adhesions were present on the apical pleura and the indwelling catheter was found to be in the lumen of the left subclavian vein. Haemostasis was secured and the patient made good postoperative progress.

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Section: Discussionmentioning

confidence: 99%

Haemothorax after subclavian vein cannulation.

Holt¹,

Kirkham²,

Myerscough³

1977

Thorax

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“…Yoffa (1965) described a supraclavicular approach with a low incidence of complications. Defalque (1968) describes several complications of subclavian puncture. Infection, thrombosis, catheter sequestration and haematomas are common to all intravenous cannulae.…”

Section: Discussionmentioning

confidence: 99%

Acute haemothorax—a hazard of subclavian vein cannulation

Thurlow

Chilvers

1972

Postgraduate Medical Journal

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DIRECT infusion of fluid into the pleural cavity via a cannula is a dangerous complication of subclavian venepuncture. Three previous cases have been reported (Smith et al., 1965;Matz, 1965;Schapira & Stern, 1967 On arrival in the operating theatre he had a blood pressure of 80/40 mmHg and the subclavian cannula recorded a pressure of + 2 cm H20 with good respiratory fluctuation. Laparotomy revealed pyloric stenosis with a pre-pyloric ulcer 5 cm in diameter. Control of the haemorrhage was achieved and a Polya partial gastrectomy done.During the anaesthetic it was noticed that respiratory movement was reduced on the left side of the chest. Auscultation revealed reduced air entry on that side. The endotracheal tube was withdrawn to its limit in case of right bronchial intubation. Endotracheal suction and hyperventilation was carried out with no improvement. As the patient's colour was good and as there had been no deterioration during the anaesthetic it was decided to complete the operation and assess the chest fully afterwards. During the operation a further 8 units of blood were given into the saphenous vein cannulae. The left subclavian vein cannula was used for monitoring venous pressure.Throughout it showed a good respiratory swing and recorded pressures varying from 0 to + 6 cm H20.After operation, a chest X-ray taken on the table showed a large left pleural effusion (Fig. 1). A diagnostic tap showed this to be blood. A size 20 Argyle chest drain was inserted into the second intercostal space in the mid clavicular line of the front of the left chest. Four litres of blood were removed from the chest. The chest movements improved and air entry became normal.Fifteen millilitres of 40Y Hypaque were injected down the subclavian cannula and a further chest X-ray taken (Fig. 2). This showed the cannula lying freely in the pleural cavity with overspill of the dye. The cannula was withdrawn and a compression dressing put on the neck.Flo. 1. Chest X-ray showing haemothorax before aspiration.

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“…The following data were among those retrieved: (1) appropriate justification for the procedure, including the need for hyperalimentation, lack of peripheral access to the venous system, severe trauma, need to monitor right-sided heart function (eg, central venous pressure measurements), and need for central vein cathe¬ terization for drug administration; (2) progress notes and radiology reports that indicated the presence of complications; (3) …”

Section: Methodsmentioning

confidence: 99%

Percutaneous subclavian vein catheterization. Too much of a good thing?

Lockwood¹

1984

Archives of Internal Medicine

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Eighty-one percutaneous subclavian vein catheterizations ( PSVCs ) were randomly selected for retrospective audits. Physicians with varied levels of experience were performing PSVCs in many patient care areas. The incidence of pneumothorax was 12.4%. After impersonal contacts by the audit committee failed to reduce that rate, a concurrent audit process with direct physician contact was initiated. This reduced the complication rate significantly. Because earlier published reports had associated PSVCs with low complication rates, operator caution may have given way to overzealous use by undertrained physicians. Direct physician involvement in quality-assurance programs can enhance patient care.

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Subclavian Venipuncture

Cited by 53 publications

References 0 publications

Haemothorax after subclavian vein cannulation.

Haemothorax after subclavian vein cannulation.

Acute haemothorax—a hazard of subclavian vein cannulation

Percutaneous subclavian vein catheterization. Too much of a good thing?

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