Preventing mechanical complications associated with central venous catheter placement

Question 1

Mechanical complications associated with CVC placement and their management

Answer 1

Arterial puncture
- Leave CVC in-situ and consult the vascular team

Azygous cannulation
- Remove immediately to prevent perforation

Direct vascular injury +/- dissection
- Consult vascular surgery depending on severity

Venous air embolism
- Supportive, FiO2 1.0 attempt to aspirate air from CVC

Extravascular placement
- Leave in-situ and get CT

Pneumothorax
- Needle decompression or ICD insertion

Pericardial effusion
- Consult cardiothoracic team

Chylothorax
- IR embolisation

Guidewire embolism or retention
- Endovascular removal

Question 2

RFx for CVC placement complications

Answer 2

• Coagulopathy
• Difficult anatomy- obesity, previous cardiac surgery, lines already in-situ
• Patient agitation
• Operator inexperience
• Site of cannulation and type of CVC device
• Number of attempts
• Lack of use of confirmation tests

Question 3

Strategies to reduce the risk of CVC placement complications

Answer 3

• Most experienced operator
• Limit no of attempts to 2
• USS guided
• Right-sided lines when possible
• IJV when possible
• Manometry, USS, paired blood gas and CXR confirmation testing