Abstract
Massive bleeding into pleural cavity after subclavian vein cannulation is a rather rare but very serious complication. Usually laceration of the venous wall is the cause. In patients where conservative treatment, i.e. pleural drainage, maintaining the circulatory volume, treatment of possible coagulopathy, etc. is ineffective, surgery has to be performed. Bleeding can be surgically managed either from posterolateral thoracotomy or direct subclavian vessel revision is possible after partial resection of the clavicle. Brachiocephalic vein bleeding can be approached and managed through median sternotomy. We present a case report of 22-year old man with hemothorax after subclavian vein cannulation. In our patient only complex surgical procedure enabled proper management of bleeding complication.
Highlights
22-year old man was referred for urgent dialysis because of suspected methanol intoxication
As the patient was severely shocked and hypotensive a chest tube was inserted immediately into his left pleural cavity and simultaneously massive volume replacement was begun via several venous lines
When hemothorax appears as a complication of subclavian vein cannulation, it can be managed conservatively by performing pleural drainage, maintaining the circulation volume by supplying blood and fluids and, last but not least, restoring coagulation parameters [4]
Summary
Summary: Massive bleeding into pleural cavity after subclavian vein cannulation is a rather rare but very serious complication. We present a case report of 22-year old man with hemothorax after subclavian vein cannulation. In our patient only complex surgical procedure enabled proper management of bleeding complication. Subclavian vein is cannulated for this purpose. Aubaniac first described this technique in 1952 [1]. Pneumothorax is the most frequent serious complication of subclavian vein cannulation. Much less frequent but more serious complications are hemothorax and hemomediastinum. Laceration of subclavian vein can be the cause Another source of hemothorax can be subclavian artery laceration. The incidence of arterial puncture during subclavian vein cannulation is reported to be approximately 4 % [2].
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