Severe vascular complications of central venous line placement

Abstract

Objective: To determine the outcome and management of iatrogenic neck-vessel complications after central venous line placement (CVLP). Design: Retrospective study. Setting: Department of Cardiovascular Surgery and the Intensive Care Unit of a 1000-bed university hospital. Patients: Eleven patients with acute central venous line placement complications were identified between 1998 and 2002. Of them, eight were inadvertent arterial punctures (one cannulation of the vertebral artery, one resulting in late pseudoaneurysm formation). There were eight lacerations of carotid, subclavian, or vertebral arteries, two perforations of the superior vena cava, and one uncontrollable jugular venous bleeding. Intervention: Eight arterial cannulations were treated operatively: suture of the artery was performed in five; litigation in one; one pseudoaneurysm was reconstructed; one pleural empyema was evacuated after initial conservative management. One uncontrollable jugular vein bleeding was treated operatively, one perforation of the superior vena cava conservatively, one surgically. Results: Two patients died: one intraoperatively due to uncontrollable bleeding after inadvertent cannulation of the subclavian artery; one arterial laceration resulted in a large subpleural hematoma, which led to an empyema. The patient died from sepsis two weeks after the initial complication. Both high-risk patients suffered from pulmonary hypertension. The other surgically treated patients made an uneventful recovery. Conclusion: Arterial complications of CVLP are very rare, but may be life-threatening. Venous perforations may seal spontaneously, but bleeding can be uncontrollable. In highly selected cases, vascular surgical consultation may be advantageous, when 24-hour service is available. Open exploration or radiological intervention may be considered.